CAJ | 학술논문

目的总结经皮内窥镜腰椎间盘切除术( PELD)治疗腰椎间盘突出症中出现的并发症,探讨其处理对策.方法 2002年7月至2010年10月采用PELD治疗腰椎间盘突出症患者689例,男性448例,女性241例;年龄13 ～84岁,平均39.8岁.单间隙椎间盘突出669例,双间隙椎间盘突出19例,三间隙椎间盘突出l例.中央型突出66例,旁中央型365例,外侧型242例,极外侧型10例,游离型6例.观察术中和术后并发症及其处理.结果术中髓核部分残留压迫神经根5例,2例术中改行开窗髓核切除术,2例二期行开窗髓核切除术,1例二期行经椎间孔腰椎体间融合术(TLIF);神经根纤维束部分损伤2例,术后3～6个月内完全恢复;硬脊膜破裂2例,给予缝合皮肤伤口后痊愈.689例患者随访6～96个月,平均33个月.出现椎间隙感染7例,1例保守治疗,4例给予经皮穿刺置管冲洗引流持续局部应用抗生素,2例行后路开窗感染腰椎间盘清除术,均痊愈;术后复发6例,4例患者再次行PELD术,2例患者采用TLIF治疗,术后症状缓解;术后神经根性痛觉过敏和灼样神经根痛19例,经过止痛药物、神经营养药及物理治疗后好转;腰椎管狭窄症行单个节段的PELD术,效果不佳,二期行多节段TLIF治疗10例.结论术中主要并发症有髓核部分残留压迫神经根、神经根纤维束部分损伤、硬脊膜破裂;术后主要并发症有椎间隙感染、复发、神经根性痛觉过敏和灼样神经根痛等.严格的适应证选择、无菌、熟练操作及术后康复锻炼可以减少并发症的发生.
목적 총결경피내규경요추간반절제술( PELD)치료요추간반돌출증중출현적병발증,탐토기처리대책.방법 2002년7월지2010년10월채용PELD치료요추간반돌출증환자689례,남성448례,녀성241례;년령13 ～84세,평균39.8세.단간극추간반돌출669례,쌍간극추간반돌출19례,삼간극추간반돌출l례.중앙형돌출66례,방중앙형365례,외측형242례,겁외측형10례,유리형6례.관찰술중화술후병발증급기처리.결과 술중수핵부분잔류압박신경근5례,2례술중개행개창수핵절제술,2례이기행개창수핵절제술,1례이기행경추간공요추체간융합술(TLIF);신경근섬유속부분손상2례,술후3～6개월내완전회복;경척막파렬2례,급여봉합피부상구후전유.689례환자수방6～96개월,평균33개월.출현추간극감염7례,1례보수치료,4례급여경피천자치관충세인류지속국부응용항생소,2례행후로개창감염요추간반청제술,균전유;술후복발6례,4례환자재차행PELD술,2례환자채용TLIF치료,술후증상완해;술후신경근성통각과민화작양신경근통19례,경과지통약물、신경영양약급물리치료후호전;요추관협착증행단개절단적PELD술,효과불가,이기행다절단TLIF치료10례.결론 술중주요병발증유수핵부분잔류압박신경근、신경근섬유속부분손상、경척막파렬;술후주요병발증유추간극감염、복발、신경근성통각과민화작양신경근통등.엄격적괄응증선택、무균、숙련조작급술후강복단련가이감소병발증적발생.
Objective To summarize and discuss the lapsus and the treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy (PELD).Methods Between July 2002 and October 2010,689 patients with lumbar intervertebral disc herniation treated by PELD were analyzed,including 448 males,and 241 females.Single lumbar intervertebral disc herniation were 669 cases.double lumbar intervertebral disc herniation were 19; three lumbar intervertebral disc herniation were 1.Central type in 66,side central type in 365,lateral type in 242,extreme lateral type in 10,sequestered type in 6.These cases with complications in operation and postoperation were studied retrospectively.Results There were nucleus pulposus omissions in 5 patients and 2 patients underwent open resection of nucleus pulposus during operation immediately and the second operation was needed in 3 cases,1 case with transforaminal lumbar interbody fusion (TLIF) and the others with open resection of nucleus pulposus.Two patients had nerve root injury,but all completely recovered in 3-6 months after operation.Spinal dura mater disruption was in 2 patients,recovered after suturing of skin wound.All 689 patients were followed up for 6-96 months,mean follow-up time was 33 months.Postoperative spondylodiscitis was in 7 patients,recovery after expectant treatment in 1,pereutaneous puncture irrigation and drainage for continued use of local antibiotics in 4,posterior infective lumbar discectomy in 2.Postoperative relapse was in 6 patients,operated secondly by PELD in 4 and by TLIF in 2,recovery after the second operation.Nerve root induced hyperalgesia and burning-like nerve root pain was seen in 19 patients,the symptom was improved by analgesic drug,neurotrophy drug and physiotherapy.The effect of single segment PELD was not good in 10 patients with spinal stenosis,who underwent multiple segment TLIF later.Conclusions The complications during operation usually are nucleus pulposus omissions,nerve root injury,spinal dura mater disruption.Accordingly the complications after operation include spondylodiscitis,recurrence,nerve root induced hyperalgesia or burning-like nerve root pain.Strict indication,aseptic technique,skilled operation and proper rehabilitation exercise are effective ways to reduce complications.