CAJ | 학술논문

目的探讨自动神经牵开器在显微内镜椎间盘切除术(micro-endoscopic discectomy,MED)中的作用与临床效果.方法回顾性分析2009年8月至2010年12月,应用MED治疗腰椎间盘突出症350例患者资料,男196例,女154例；年龄17～68岁,平均42岁；L1-23例,L2-3 8例,L3-4 12例,L4-5 186例,L5S1 141例.突出类型:中央型31例,旁侧型266例,极外型23例,破裂游离型30例.其中合并钙化37例,合并椎管狭窄66例.患者在MED中均应用自动神经牵开器.采用视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)评估患者术后疗效.结果 350例患者均获得随访,随访时间6～16个月,平均9个月.VAS评分,术前(8.79±1.15)分,术后3个月(3.80±1.14)分,术后6个月(3.65±1.14)分.ODI,术前78％±1.71％,术后3个月28％±1.72％,术后6个月28％±1.88％.术后各个时间点VAS评分和ODI均较术前有明显改善,术后各时间点比较无明显差异.术后无一例发生脊髓及神经根损伤、硬膜外血肿形成.1例发生椎间隙感染,给予切吸、引流,卧床休息,消炎止痛等对症治疗3周后治愈.2例术后切口发生缝线反应导致切口延迟愈合,经拆线后清洁换药3～4周痊愈.1例术后切口发生感染,经清洁换药及对症治疗6周后痊愈.2例患者因长时间卧床缺少活动而致下肢静脉血栓形成,其中1例经物理疗法、药物及对症治疗后康复,另1例经介入放置滤网结合药物溶栓得以康复.结论在MED中配合使用自动神经牵开器可有效显露术区,保护周围神经不受损伤,减轻手术人员的工作量,有较好的临床应用价值.
목적 탐토자동신경견개기재현미내경추간반절제술(micro-endoscopic discectomy,MED)중적작용여림상효과.방법 회고성분석2009년8월지2010년12월,응용MED치료요추간반돌출증350례환자자료,남196례,녀154례；년령17～68세,평균42세；L1-23례,L2-3 8례,L3-4 12례,L4-5 186례,L5S1 141례.돌출류형:중앙형31례,방측형266례,겁외형23례,파렬유리형30례.기중합병개화37례,합병추관협착66례.환자재MED중균응용자동신경견개기.채용시각모의평분(visual analogue scale,VAS)화Oswestry공능장애지수(Oswestry disability index,ODI)평고환자술후료효.결과 350례환자균획득수방,수방시간6～16개월,평균9개월.VAS평분,술전(8.79±1.15)분,술후3개월(3.80±1.14)분,술후6개월(3.65±1.14)분.ODI,술전78％±1.71％,술후3개월28％±1.72％,술후6개월28％±1.88％.술후각개시간점VAS평분화ODI균교술전유명현개선,술후각시간점비교무명현차이.술후무일례발생척수급신경근손상、경막외혈종형성.1례발생추간극감염,급여절흡、인류,와상휴식,소염지통등대증치료3주후치유.2례술후절구발생봉선반응도치절구연지유합,경탁선후청길환약3～4주전유.1례술후절구발생감염,경청길환약급대증치료6주후전유.2례환자인장시간와상결소활동이치하지정맥혈전형성,기중1례경물리요법、약물급대증치료후강복,령1례경개입방치려망결합약물용전득이강복.결론 재MED중배합사용자동신경견개기가유효현로술구,보호주위신경불수손상,감경수술인원적공작량,유교호적림상응용개치.
Objective To explore the function and clinical effect of automatic nerve retractor in micro-endoscopic discectomy.Methods From August 2009 to December 2010,350 patients with lumbar disc hemiation were treated by micro-endoscopic discectomy,including 196 males and 154 females,aged from 17 to 68 years (average,42 years).Three cases were at L1-2,8 at L2-3,12 at L3-4,186 at L4-5 and 141 at L5S1.The automatic nerve retractor was used in all micro-endoscopic discectomy.The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate clinical outcomes.Results All patients were followed up for 6 to 16 months (average,9 months).The mean VAS score decreased from preoperative 8.79±1.15 to 3.80±1.14 3 months after operation and 3.65±1.14 6 months after operation.The mean ODI score decreased from preoperative 78％±1.71％ to 28％±1.72％ 3 months after operation and 28％±1.88％ 6 months after operation.Postoperative VAS and ODI scores decreased significantly compared with those before operation.The VAS and ODI scores 6 months after operation were not significantly improved compared with those 3 months after operation.No spinal cord and nerve root injury and epidural hematoma formation occurred in all cases.Conclusion In micro-endoscopic discectomy,the automatic nerve retractor can help the operator obtain effective exposure,protect nerves from injury,alleviate workload of the operators,therefore it has a great clinical application value.