完全内窥镜下经椎板间入路手术治疗腰椎间盘突出症中期临床疗效
완전내규경하경추판간입로수술치료요추간반돌출증중기림상료효
Mid-term clinical outcomes of full-endoscopic interlaminar approach for lumbar disc herniation
  • 万方数据
    中国骨与关节杂志 중국골여관절잡지
    Chinese Journal of Bone and Joint
    2014年 8期 603-607 ,共5页

    王冰%吕国华%李亚伟%李磊%邝磊%周乾%李鹏志

    왕빙%려국화%리아위%리뢰%광뢰%주건%리붕지

    椎间盘移位%内窥镜检查%椎板切除%腰椎%外科手术,微创性 椎間盤移位%內窺鏡檢查%椎闆切除%腰椎%外科手術,微創性
    추간반이위%내규경검사%추판절제%요추%외과수술,미창성
    Intervertebral disc displacement%Endoscopy%Laminectomy%Lumbar vertebrae%Surgical procedures,minimally invasive
    目的：评价完全内窥镜(full-endoscopic，FE)下经椎板间入路手术治疗腰椎间盘突出症的中期临床疗效。方法2008年8月至2010年2月，我院应用FE经椎板间入路手术治疗腰椎间盘突出症患者45例，男25例，女20例；年龄19～58岁，平均38.3岁。术前、术后3个月、术后1年和末次随访进行腿、腰痛视觉模拟评分(visualanalogescale，VAS)和腰椎Oswestry功能障碍指数(oswestrydisabilityindex，ODI)评定，参照改良MacNab标准评价临床疗效，并进行统计学分析。结果所有病例手术均顺利完成，平均手术时间62.4min；平均住院时间5.2天；2例术中出现硬膜小裂口，未予处理；无神经根损伤及术后出血等并发症发生。术后随访48～66个月。腿痛VAS评分从术前(7.6±1.6)分降至术后3个月(1.2±0.8)分、术后1年(1.1±0.9)分、末次随访(1.6±1.2)分(P＜0.01)，末次随访与术后1年比较，差异无统计学意义(P＞0.05)；腰痛VAS评分从术前(3.1±2.2)分降至术后3个月(1.8±1.5)分、术后1年(1.6±1.4)分、末次随访(1.7±0.9)分(P＜0.01)，末次随访与术后1年比较，差异无统计学意义(P＞0.05)；腰椎ODI指数从术前(69.5±10.5)降至术后3个月(19.3±6.5)、术后1年(15.6±5.9)、末次随访(21.8±7.0)(P＜0.01)，末次随访与术后1年比较，差异无统计学意义(P＞0.05)。末次随访时，93.3%的患者获得良好的主观满意度，临床疗效优良率为88.9%。性别、年龄、突出类型及术前腰痛与改良MacNab结果无相关性(P＞0.05)；而术前Pfirrmann分级、感觉缺陷及手术节段与改良MacNab结果具相关性(P＜0.05)。1例L4～5节段患者术后1周发生下肢麻木加重，予以脱水、激素治疗等保守治疗后2周症状缓解；1例L5～S1节段患者术后4个月出现手术节段椎间盘再次突出，行小切口开放手术翻修。末次随访时，2例轻度运动障碍，6例感觉异常，但较术前均显著改善。结论 FE下经椎板间入路手术治疗腰椎间盘突出症不仅具有创伤小、出血量和并发症少、术后恢复快的优点，而且可以获得满意的中期临床疗效。
    목적：평개완전내규경(full-endoscopic，FE)하경추판간입로수술치료요추간반돌출증적중기림상료효。방법2008년8월지2010년2월，아원응용FE경추판간입로수술치료요추간반돌출증환자45례，남25례，녀20례；년령19～58세，평균38.3세。술전、술후3개월、술후1년화말차수방진행퇴、요통시각모의평분(visualanalogescale，VAS)화요추Oswestry공능장애지수(oswestrydisabilityindex，ODI)평정，삼조개량MacNab표준평개림상료효，병진행통계학분석。결과소유병례수술균순리완성，평균수술시간62.4min；평균주원시간5.2천；2례술중출현경막소렬구，미여처리；무신경근손상급술후출혈등병발증발생。술후수방48～66개월。퇴통VAS평분종술전(7.6±1.6)분강지술후3개월(1.2±0.8)분、술후1년(1.1±0.9)분、말차수방(1.6±1.2)분(P＜0.01)，말차수방여술후1년비교，차이무통계학의의(P＞0.05)；요통VAS평분종술전(3.1±2.2)분강지술후3개월(1.8±1.5)분、술후1년(1.6±1.4)분、말차수방(1.7±0.9)분(P＜0.01)，말차수방여술후1년비교，차이무통계학의의(P＞0.05)；요추ODI지수종술전(69.5±10.5)강지술후3개월(19.3±6.5)、술후1년(15.6±5.9)、말차수방(21.8±7.0)(P＜0.01)，말차수방여술후1년비교，차이무통계학의의(P＞0.05)。말차수방시，93.3%적환자획득량호적주관만의도，림상료효우량솔위88.9%。성별、년령、돌출류형급술전요통여개량MacNab결과무상관성(P＞0.05)；이술전Pfirrmann분급、감각결함급수술절단여개량MacNab결과구상관성(P＜0.05)。1례L4～5절단환자술후1주발생하지마목가중，여이탈수、격소치료등보수치료후2주증상완해；1례L5～S1절단환자술후4개월출현수술절단추간반재차돌출，행소절구개방수술번수。말차수방시，2례경도운동장애，6례감각이상，단교술전균현저개선。결론 FE하경추판간입로수술치료요추간반돌출증불부구유창상소、출혈량화병발증소、술후회복쾌적우점，이차가이획득만의적중기림상료효。
    Objective To evaluate the mid-term clinical outcomes of full-endoscopic ( FE ) interlaminar approach for lumbar disc herniation. Methods A retrospective study of 45 patients with lumbar disc hernation undergoing FE interlaminar approach from August 2008 to February 2010 was carried out. There were 25 males and 20 females, whose mean age was 38.3 years old ( range:19-58 years ). The Visual Analogue Scale ( VAS ) of low back pain and leg pain and Oswestry Disability Index ( ODI ) were evaluated preoperatively, at 3 months and 1 year after the operation and in the latest follow-up. The modiifed Macnab criteria was used to assess the clinical outcomes, and all the data was statistically analyzed. Results The operation was successfully completed in all the patients. The mean operation time was 62.4 min, and the mean length of hospital stay was 5.2 d. Small dural tears were noticed during the operation in 2 patients, which were not handled. There were no nerve root injuries or postoperative blood loss. All the patients were followed up from 48 to 66 months. The VAS score of leg pain was ( 7.6±1.6 ) points preoperatively, which was reduced to ( 1.2±0.8 ), ( 1.1±0.9 ) and ( 1.6±1.2 ) points at 3 months and 1 year after the operation and in the latest follow-up respectively ( P<0.01 ). No statistically signiifcant differences existed between the scores in the latest follow-up and that at 1 year after the operation ( P>0.05 ). The VAS score of low back pain was ( 3.1±2.2 ) points preoperatively, which was reduced to ( 1.8±1.5 ), ( 1.6±1.4 ) and ( 1.7±0.9 ) points at 3 months and 1 year after the operation and in the latest follow-up respectively ( P<0.01 ). No statistically signiifcant differences existed between the scores in the latest follow-up and that at 1 year after the operation ( P>0.05 ). The ODI score was ( 69.5±10.5 ) points preoperatively, which was reduced to ( 19.3±6.5 ), ( 15.6±5.9 ) and ( 21.8±7.0 ) points at 3 months and 1 year after the operation and in the latest follow-up respectively ( P<0.01 ). No signiifcant differences existed between the scores in the latest follow-up and that at 1 year after the operation ( P>0.05 ). In the latest follow-up, good subjective satisfaction was noticed in 93.3%of the patients, and the clinical excellent and good rate was 88.9%. There was no correlation between the results based on the modiifed Macnab criteria and the gender, age, type of disc herniation and preoperative low back pain ( P>0.05 ). However, significant correlation was found between the results based on the modified Macnab criteria and the preoperative Pifrrmann grading, sensation deifcits and surgical segments ( P<0.05 ). A patient with L4-5 disc herniation had worsened lower limb numbness at 1 week after the operation, who underwent dehydration and hormonotherapy and got relieved at 2 weeks after the traditional treatment. Reherniation of the surgical disc was detected at 4 months after the operation in 1 patient with L5-S1 disc herniation, who then received small-incision open surgery. In the latest follow-up, mild dyskinesia occurred to 2 patients and paresthesia to 6 patients, which were obviously improved when compared with the preoperative symptoms. Conclusions Satisfactory mid-term clinical outcomes can be achieved by FE interlaminar approach for lumbar disc herniation, with the advantages of less trauma, blood loss and complications and rapid postoperative recovery.
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