CAJ | 학술논문

目的探讨经皮激光椎间盘减压术(PLDD)治疗多节段腰椎间盘突出症的临床策略及疗效.方法 2005年12月至2008年12月收治56例多节段腰椎间盘突出症患者.局部麻醉下,应用Nd:YAG激光治疗,术中在数字减影血管造影(DSA)机透视下定位,光纤由浅入深插入烧灼,每次发射1 s,间歇1 s,单节段激光总量400～800 J.于术前、术后3个月进行视觉模拟疼痛量表(VAS)及奥斯维斯失能指数(ODI)评分,末次随访时采用改良Macnab标准评价临床疗效.结果 56例患者随访6～36个月,平均18个月,ODI评分由术前的(31.10±2.92)分改善至术后的(11.80±2.62)分(t=3.067,P＜0.01);VAS评分由术前的(7.00±1.41)分改善至术后的(3.00±0.81)分(t=2.802,P＜0.01).优36例,良10例,可8例,差2例,优良率82.1%(46/56).无椎间盘感染、腰大肌血肿、神经根和血管损伤等并发症.结论 PLDD治疗多节段腰椎间盘突出症临床疗效良好,手术安全,耗时短,术后恢复快.
목적 탐토경피격광추간반감압술(PLDD)치료다절단요추간반돌출증적림상책략급료효.방법 2005년12월지2008년12월수치56례다절단요추간반돌출증환자.국부마취하,응용Nd:YAG격광치료,술중재수자감영혈관조영(DSA)궤투시하정위,광섬유천입심삽입소작,매차발사1 s,간헐1 s,단절단격광총량400～800 J.우술전、술후3개월진행시각모의동통량표(VAS)급오사유사실능지수(ODI)평분,말차수방시채용개량Macnab표준평개림상료효.결과 56례환자수방6～36개월,평균18개월,ODI평분유술전적(31.10±2.92)분개선지술후적(11.80±2.62)분(t=3.067,P＜0.01);VAS평분유술전적(7.00±1.41)분개선지술후적(3.00±0.81)분(t=2.802,P＜0.01).우36례,량10례,가8례,차2례,우량솔82.1%(46/56).무추간반감염、요대기혈종、신경근화혈관손상등병발증.결론 PLDD치료다절단요추간반돌출증림상료효량호,수술안전,모시단,술후회복쾌.
Objective To investigate the efficacy and strategy of percutaneous laser disc decompression (PLDD) for patients with multisegmental lumbar disc herniation. Methods Between December 2005 and December 2008,a total of 56 patients with multisegmental lumbar disc herniation underwent PLDD. Under local anesthesia, the operation was performed using Nd:YAG laser. A digital subtraction angiography (DSA) system was employed to guide the surgery,insert burning, each 1 s, pulse intermission gasification 1 s, single segment laser total 400-800 J. In preoperative and postoperative 3 months visual analogue scale(VAS) and Oswestry disability index (ODI) scores of times during followed up,Macnab standard to assess the clinical curative effect. Results The patients were followed up for 6 - 36 months (mean 18 months). The ODI improved from (31.10 ±2.92) scores to (11.80 ±2.62) scores (t=3.067,P ＜0.01 ). The VAS also showed postoperative improvement of pain compared with preoperative findings (7.00 ± 1.41 ) scores vs (3.00 ± 0.81 ) scores (t= 2.802,P ＜0.01 ). According to the Macnab standard, 36 patients achieved excellent outcomes, 10 were good, 8 were fair, and 2 were poor. The rate of excellent and good outoomes was 82. 1% (46/56). No patient had postoperative complications. Conclusions PLDD is effective and safe for patients with multisegmental lumbar disc berniation. The cases recover quickly after the operation, because the procedure is minimally invasive.