摘要
目的探讨经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症2年以上随访的疗效。方法2013年12月~2015年12月对80例腰椎间盘突出症行经皮穿刺椎间孔镜下腰椎间盘切除术并随访2年以上,比较患者术前后腰腿痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)、病变节段椎体活动域、病变节段椎间隙高度,采用改良MacNab标准评价疗效。结果80例随访24~35个月(平均28.5月),术前腰痛VAS评分中位数6(1~9)分,显著高于术后3个月3(1~5)分和末次随访时1(0~3)分(P<0.05);术前腿痛VAS评分中位数6(1~9)分,显著高于术后3个月2(0~6)分和末次随访时1(0~3)分(P<0.05);ODI术前(70.8±4.6)%,显著高于术后3个月(16.6±1.6)%和末次随访时(9.9±1.2)%(P均=0.000);病变节段椎体活动域(过伸位角度+过屈位角度),术前L 4~5节段椎体间角度活动域为9.62°±0.78°,显著低于术后3个月9.91°±0.72°(P=0.037),但与末次随访9.91°±0.61°无统计学差异(P=0.058);L 5~S 1节段椎体间角度活动域术前、术后3个月和末次随访分别为10.78°±1.27°、10.84°±1.43°和°,10.92°±0.97°,术前后比较差异无显著性(F=0.260,P=0.771);病变节段椎间隙高度术前(6.52±1.12)mm,与术后3个月(6.38±0.93)mm和末次随访(6.42±1.29)mm无统计学差异(F=0.329,P=0.720)。按改良MacNab标准,末次随访患者术后优良率95.0%(76/80)。结论经皮椎间孔镜治疗腰椎间盘突出症创伤小,恢复快,能明显缓解症状,中期临床疗效可靠。
Objective To analyze the clinical effect of percutaneous transforminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation.Methods A total of 80 patients with lumbar disc herniation were treated with PTED from December 2013 to December 2015.They were followed up for more than 2 years.The Visual Analogue Scale(VAS),Oswestry Disability Index(ODI),vertebral body activity domain of lesion segments,intervertebral height of lesion segments,and modified MacNab standard were evaluated before and after operation.Results The 80 cases were followed up for 24-35 months(mean,28.5 months).The VAS scores of lumbar pain were 6(1-9)points before operation,which were significantly higher than 3(1-5)points at 3 months after operation and 1(0-3)points at the last follow-up(P<0.05).The VAS scores of leg pain were 6(1-9)points before operation,which were significantly higher than 2(0-6)points at 3 months after operation and 1(0-3)points at the last follow-up(P<0.05).The ODI before surgery(70.8±4.6)%was significantly higher than that at 3 months after surgery(16.6±1.6)%and at the last follow-up(9.9±1.2)%(all P=0.000).The vertebral body activity domain of lesion segments(hyperextension angle+hyperflexion angle)was 9.62°±0.78°at L 4-5 segments before surgery,which was significantly lower than 3 months after operation(9.91°±0.72°,P=0.037),but had no significant difference with the last follow-up(9.91°±0.61°,P=0.058).The vertebral body activity domain of L 5-S 1 segments was 10.78°±1.27°,10.84°±1.43°,and 10.92°±0.97°before operation,3 month after operation,and at the last follow-up,without significant differences between preoperation and postoperation(F=0.260,P=0.771).The intervertebral height of lesion segments was(6.52±1.12)mm before operation,and there was no significant change with(6.38±0.93)mm at 3 months after operation and(6.42±1.29)mm at the last follow-up(F=0.329,P=0.720).The excellent and good rate of the patients was 95.0%(76/80)at the last follow-up according to the modified MacNab standard.Conclusions PTED has minimal invasion and rapid recovery.It can alleviate symptoms obviously in the treatment of lumbar disc herniation,having a reliable mid-term curative effect.
作者
王大巍
邵滨
邢建强
房清敏
孙兆忠
Wang Dawei;Shao Bin;Xing Jianqiang(Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou 256601, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第4期326-329,共4页
Chinese Journal of Minimally Invasive Surgery
