CAJ | 학술논문

目的探讨经皮内镜椎板间入路髓核摘除术( percutaneous endoscopic lumber discectomy,PELD )治疗腰椎间盘突出症( lumber disc herniation,LDH )的临床疗效.方法对2011年9月至2012年8月采取经皮椎板间隙入路椎间孔镜下髓核摘除术治疗的42例 L5,S1腰椎间盘突出症患者进行回顾性分析,采用疼痛视觉类比评分( visual analogue scale,VAS )和 Oswestry 功能障碍指数( oswestry disability index,ODI )评估临床疗效.其中,男29例,女13例;平均年龄39.2(21~55)岁;平均病程9.3(5~16)个月.42例均为单侧突出或旁中央型,突出21例,脱出15例,游离脱垂6例.结果所有病例均顺利完成手术,平均手术时间68.7(50~100) min;平均出血量10.8(5~20) ml;平均术后住院时间3.5(2~7)天;术后均获随访,平均随访8.4(5~13)个月.出院时 VAS 评分为(3.0±0.6)分,与术前(7.2±1.1)分相比,差异有统计学意义( P<0.001),末次随访时 VAS 评分为(2.0±0.8)分,又有进一步改善( P<0.001).末次随访时 ODI 评分为(17.6±4.4)分,较术前(64.8±5.5)分有明显改善( P<0.001).术中 S1神经根挫伤导致跖屈肌力下降2例,经保守治疗后恢复正常或症状好转;硬膜囊撕裂1例,但术后未出现脑脊液漏;1例术后复发再次行翻修术.结论经皮椎板间隙入路椎间孔镜下髓核摘除术创伤小,操作安全、术后恢复快,临床疗效满意,尤其对于髂嵴较高的 L5,S1腰椎间盘突出症患者具有独特的优势.
목적탐토경피내경추판간입로수핵적제술( percutaneous endoscopic lumber discectomy,PELD )치료요추간반돌출증( lumber disc herniation,LDH )적림상료효.방법대2011년9월지2012년8월채취경피추판간극입로추간공경하수핵적제술치료적42례 L5,S1요추간반돌출증환자진행회고성분석,채용동통시각류비평분( visual analogue scale,VAS )화 Oswestry 공능장애지수( oswestry disability index,ODI )평고림상료효.기중,남29례,녀13례;평균년령39.2(21~55)세;평균병정9.3(5~16)개월.42례균위단측돌출혹방중앙형,돌출21례,탈출15례,유리탈수6례.결과소유병례균순리완성수술,평균수술시간68.7(50~100) min;평균출혈량10.8(5~20) ml;평균술후주원시간3.5(2~7)천;술후균획수방,평균수방8.4(5~13)개월.출원시 VAS 평분위(3.0±0.6)분,여술전(7.2±1.1)분상비,차이유통계학의의( P<0.001),말차수방시 VAS 평분위(2.0±0.8)분,우유진일보개선( P<0.001).말차수방시 ODI 평분위(17.6±4.4)분,교술전(64.8±5.5)분유명현개선( P<0.001).술중 S1신경근좌상도치척굴기력하강2례,경보수치료후회복정상혹증상호전;경막낭시렬1례,단술후미출현뇌척액루;1례술후복발재차행번수술.결론경피추판간극입로추간공경하수핵적제술창상소,조작안전、술후회복쾌,림상료효만의,우기대우가척교고적 L5,S1요추간반돌출증환자구유독특적우세.
Objective To investigate the clinical outcomes of percutaneous endoscopic lumbar discectomy ( PELD ) through trans-interlaminar approach in the treatment of lumber disc herniation. Methods A retrospective study was performed on 42 patients with L5, S1 lumbar disc herniation who underwent PELD through trans-interlaminar approach from September 2011 to August 2012. The Visual Analogue Scale ( VAS ) and Oswestry Disability Index ( ODI ) were used to assess the clinical outcomes. There were 29 males and 13 females, with an average age of 39.2 years old ( range; 21-55 years ). The mean course of disease was 9.3 months ( range; 5-16 months ). All patients were unilateral prominent or paracentral type, including prominent in 21 cases, prolapse in 15 cases and free prolapse in 6 cases. Results The surgeries were performed on all patients successfully, and the average operation time was 68.7min ( range; 50-100 min ). The mean blood loss was 10.8ml ( range: 5-20 ml ), and the mean postoperative hospital stay was 3.5 days ( range; 2-7 days ). All patients were followed up for a mean period of 8.4 months ( range: 5-13 months ). The VAS score at discharge was ( 3.0±0.6 ), and there were statistically significant differences when compared with that preoperatively ( P<0.001 ). The VAS score in the latest follow-up was ( 2.0±0.8 ), which was further improved ( P<0.001 ). The ODI score in the latest follow-up was ( 17.6±4.4 ), which was significantly improved when compared with those preoperatively ( P<0.001 ). The strength of flexor hallucis longus was decreased in 2 patients due to the intraoperative S1 nerve root injuries, who got recovered or whose symptoms got improved after the conservative treatment. Dural tear occurred in 1 case, without the cerebrospinal fluid leakage postoperatively. 1 patient underwent revision surgery due to the postoperative recurrence. Conclusions With minimal invasion, safe operation, rapid postoperative recovery and good clinical outcomes, PELD through trans-interlaminar approach is suitable for the patients with higher iliac crest and L5, S1 lumbar disc herniation in particular.