摘要
[目的]探讨经皮椎间孔镜技术治疗腰椎融合术后相邻节段退变的临床疗效。[方法]回顾性分析2010年8月~2015年8月于本院应用经皮椎间孔镜治疗并获得随访的23例腰椎融合术后相邻节段退变患者的临床资料,采用视觉模拟评分法(visual analogue scale/score,VAS)评估手术疗效,应用日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分对腰椎功能进行评估,并计算JOA改善率,术后1年改良Mac Nab标准评估临床疗效。[结果]手术时间40~85 min,平均55 min;出血量5~25 ml,平均10 ml;住院时间3~14 d,平均7 d。所有患者随访6~24个月,平均13.5个月。术前VAS评分为(7.13±0.54)分,术后3 d为(2.05±0.34)分,末次随访为(1.41±0.28)分。术前与术后3 d、末次随访比较差异有统计学意义(P<0.01);术前JOA评分为(9.89±0.53)分,出院当天评分为(18.23±2.25)分,末次随访评分为(28.41±2.34)分,术前与出院时、末次随访比较差异有统计学意义(P<0.01)。根据JOA评分标准计算改善率,优18例,良3例,可1例,差1例;术后1年优良率为91.3%。[结论]应用经皮椎间孔镜治疗腰椎融合术后相邻节段退变性疾病疗效确切,具有创伤小、手术时间短、恢复快、术后并发症少等优点。
[Objective] To explore the clinical outcomes of percutaneous endoscopic lumbar diseectomy（PELD） for treatmtent of adjacent segment degeneration disease after lumbar fusion surgery.[Methods] Twenty-three eases of adjacent segment degenerative disease after lumbar fusion received PELD therapy from August 2010 to August 2015. Postoperatively, the visual analogue scale （VAS） was used to assess the efficacy of surgery, and the Japanese Orthopaedic Association （JOA） evaluation was carried out to assess the function of the lumbar spine, as well as the improvement rate. One year after surgery＇, the overall curative effect was evaluated by modified MacNab criteria. [Results] The surgery time ranged from 40 to 85 minutes, with an average of 55 minutes. The blood loss ranged from 5 to 25 ml, with an average of 10 ml. The average hospital stay was 7 days （range, 3-14 clays）. All patients were followed up for 6 to 24 months, with an average of 13.5 months. The VAS scores before surgery, at 3 days after surgery and at the last folow-up were （7.13 ± 0.54）, （2.05 ± 0.34）, （1.41 ±0.28） points, respectively. The preoperative VAS score showed significant differences from those at 3 days postoperatively and at the last follow-up （P 〈 0.01）. JOA scores before surgery, at discharge day and at the last follow-up were （9.89±0.53）, （18.23±2.25）, （28.41±2.34） points, respectively. The preoperative JOA score also showed significant differences from those at discharge clay and at the last follow-up（P 〈 0.01）. JOA score improvement rate was calculated and revealed excellent outcome in 18 eases, good in 3 eases, fair in 1 case and poor in 1 case. The overall excellent and good outcomes rate was 91.3% at l year after surgery .[Conclusion] Percutaneous endoscopiclumbar discectomy, with advantages of less trauma, shorter operative time, quicker recovery, fewer complications, is effective for the treatment of adjacent segment degeneration after lumbar fusion surgery.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第2期170-173,共4页
Orthopedic Journal of China
