CAJ | 학술논문

目的：探讨经皮椎间孔镜靶向穿刺分步法治疗腰椎间盘突出症的临床疗效。方法选取我院2014年1—6月经皮椎间孔镜技术治疗腰椎间盘突出症患者36例，采用视觉模拟评分法(VAS)评价手术前后的腰痛和下肢痛，Oswestry功能障碍指数（ODI）及MacNab标准评估手术效果。结果所有患者均顺利完成手术。手术时间（125±31）min，术中出血（8.5±2.9）mL，平均住院时间（7.6±3.5）d。出院时及末次随访腰痛、下肢痛VAS评分均低于术前，末次随访时的ODI（73.30±18.21）%高于术前（18.90±7.78）%，差异均有统计学意义。MacNab疗效评定优良率94.4%。1例术后出现了L4神经根支配区的痛觉过敏，经保守治疗后好转，无神经损伤、脑脊液漏、感染等并发症。其余患者随访期间疗效稳定，无间盘突出复发。结论靶向穿刺结合分步法经皮腰椎间盘摘除术可摘除突出及间隙内间盘组织，达到充分减压并防止复发的目的，具有微创、安全、康复快、住院时间短等优点。
목적：탐토경피추간공경파향천자분보법치료요추간반돌출증적림상료효。방법선취아원2014년1—6월경피추간공경기술치료요추간반돌출증환자36례，채용시각모의평분법(VAS)평개수술전후적요통화하지통，Oswestry공능장애지수（ODI）급MacNab표준평고수술효과。결과소유환자균순리완성수술。수술시간（125±31）min，술중출혈（8.5±2.9）mL，평균주원시간（7.6±3.5）d。출원시급말차수방요통、하지통VAS평분균저우술전，말차수방시적ODI（73.30±18.21）%고우술전（18.90±7.78）%，차이균유통계학의의。MacNab료효평정우량솔94.4%。1례술후출현료L4신경근지배구적통각과민，경보수치료후호전，무신경손상、뇌척액루、감염등병발증。기여환자수방기간료효은정，무간반돌출복발。결론파향천자결합분보법경피요추간반적제술가적제돌출급간극내간반조직，체도충분감압병방지복발적목적，구유미창、안전、강복쾌、주원시간단등우점。
Objective To evaluate the effect of percutaneous transforaminal endoscopic discectomy (PTED) using tar?get puncture and 2-stage procedures in treating lumbar disc hernia. Methods Patients present in our clinic from January 2014 to June 2014 with lumbar disc hernia who were treated with PTED were collected (n=36). Lower back and leg pain were evaluated by visual analog scale (VAS) while clinic outcome were assessed by Oswestry disability index (ODI) and modified Macnab criteria. Results All surgeries were carried out successfully. On average, operation time was(125±31)min, blood loss was(8.5±2.9)mL in each operation. The average length in hospital stay was(7.6±3.5)day. Compared with the preoper?ative VAS scores,the postoperative and last follow-up scores for lower back and leg pain decreased significantly (P<0.01). The ODI of pre-operation and last follow-up were (18.90 ± 7.78)%and (73.30 ± 18.21)%respectively with statistic differ?ence. As to the modified Macnab criteria,the"excellent and good"ratio was 94.4%. One case present hyperalgesia in L4 der?matome which recovered through conservative treatment. No complications such as permanent nerve root injury ,cerebrospi?nal fluid leakage,or infection were found during or after operations. All patients are in stable conditions during follow-up pe?riod without recurrence. Conclusion PTED using target puncture and 2-stage procedures is an effective method with mini?mal trauma, less bleeding, quick recovery, high security, short hospitalization time. what′s more, it can remove protruded disc and broken nucleus from the intervertebral space. It ensure efficacy and avoid recurrence.