本文選題：經(jīng)皮椎間孔鏡技術(shù)　切入點(diǎn)：腰椎間盤(pán)突出癥　出處：《昆明醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：[目的]探討經(jīng)皮椎間孔鏡技術(shù)治療青少年腰椎間盤(pán)突出癥(Lumbar Disc Herniation, LDH)的臨床療效。[方法]選擇從2013年9月至2016年3月昆明醫(yī)科大學(xué)附屬延安醫(yī)院脊柱外科采用經(jīng)皮椎間孔鏡下髓核摘除術(shù)(Percutaneous Endoscopic Lumbar Discectomy,PELD)治療青少年腰椎間盤(pán)突出癥的病例共19例,收集患者相關(guān)數(shù)據(jù)包括:手術(shù)時(shí)間、手術(shù)切口長(zhǎng)度、術(shù)中出血量及住院時(shí)間,采用腰痛及下肢痛綜合視覺(jué)模擬法(Visual Analogue Scale,VAS)評(píng)分與日本骨科協(xié)會(huì)評(píng)估治療腰椎(Japanese Orthopaedic Association,JOA)分?jǐn)?shù)分別于術(shù)前、術(shù)后第7天、術(shù)后3個(gè)月及術(shù)后12個(gè)月,比較治療前后的療效差異,并根據(jù)術(shù)后12個(gè)月的改良Macnab評(píng)分對(duì)臨床療效進(jìn)行評(píng)價(jià)。[結(jié)果]所有19例手術(shù)均順利完成,均未產(chǎn)生術(shù)后并發(fā)癥。手術(shù)時(shí)間平均54.3分鐘,手術(shù)切口長(zhǎng)度平均0.7cm,術(shù)中出血量平均8ml,住院時(shí)間4～10平均6天。所有患者在術(shù)后3個(gè)月及術(shù)后12個(gè)月均獲得隨訪,隨訪期間均未發(fā)現(xiàn)手術(shù)相關(guān)并發(fā)癥。腰痛及下肢痛綜合VAS評(píng)分術(shù)前為(7.00±0.86),術(shù)后第7天為(2.05±0.69),術(shù)后 3 個(gè)月為(1.11±0.64),術(shù)后 12 個(gè)月為(0.63±0.58),術(shù)后與術(shù)前相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);腰椎JOA分?jǐn)?shù)術(shù)前為(9.37±0.98),術(shù)后第7天為(16.58±1.39),術(shù)后3個(gè)月為(22.95±1.05),術(shù)后12個(gè)月為(26.74±0.85),術(shù)后與術(shù)前相比,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后第7天時(shí)JOA分?jǐn)?shù)改善率(%)為(37.18±7.23),19例均為有效;術(shù)后3個(gè)月時(shí)改善率(%)為(69.12±5.39),18例顯效,1例有效;術(shù)后12個(gè)月時(shí)改善率(%)為(88.42±4.49),19例均為顯效。根據(jù)術(shù)后12個(gè)月的改良Macnab評(píng)分評(píng)價(jià)臨床療效,共19例中,11例為優(yōu)(57.9%),8例為良(42.1%),優(yōu)良率為100%。[結(jié)論]1.經(jīng)皮椎間孔鏡下髓核摘除術(shù)(PELD)是治療青少年腰椎間盤(pán)突出癥(LDH)的安全、有效的手術(shù)方式。2. PELD治療青少年LDH的遠(yuǎn)期療效及復(fù)發(fā)率以及對(duì)青少年生長(zhǎng)發(fā)育的影響情況仍需要更多臨床觀察以及更深入的研究。
[Abstract]:[objective] to evaluate the clinical efficacy of percutaneous foramen technique in the treatment of lumbar disc herniation (Lumbar Disc herniation) in adolescents. [methods] from September 2013 to March 2016, the spinal surgery of Yan'an Hospital affiliated to Kunming Medical University was selected for the treatment of lumbar intervertebral disc herniation. 19 cases of juvenile lumbar disc herniation were treated by percutaneous transhepatic Endoscopic Lumbar discectomy1 (PELDD). The data collected include the operation time, the length of the incision, the amount of blood lost during the operation and the length of hospital stay. Visual Analogue scale scale score was used to evaluate the scores of Japanese Orthopaedic Association and Japanese Orthopedic Association before operation, 7 days after operation, 3 months after operation and 12 months after operation, respectively. The clinical efficacy was evaluated according to the modified Macnab score 12 months after operation. [results] all the 19 cases were successfully completed without postoperative complications. The average operation time was 54.3 minutes. The average length of incision was 0.7 cm, the average amount of blood lost during operation was 8 ml, and the average hospital stay was 4 ~ 10 days. All the patients were followed up at 3 months and 12 months after operation. The VAS scores of low back pain and lower extremity pain were 7.00 鹵0.86 before operation, 2.05 鹵0.69 on the 7th day, 1.11 鹵0.64 at 3 months after operation and 0.63 鹵0.58 at 12 months after operation. The JOA score of lumbar vertebrae was 9.37 鹵0.98 before operation, 16.58 鹵1.39 on the 7th day after operation, 22.95 鹵1.05 at 3 months after operation and 26.74 鹵0.85 at 12 months after operation. The difference was statistically significant (P 0.05). On the 7th day after operation, the improvement rate of JOA score was significantly higher in 19 cases than that in the control group (37.18 鹵7.23%), and at 3 months after operation, the improvement rate was 69.12 鹵5.39% in 18 cases and effective in 1 case. At 12 months after operation, the improvement rate was 88.42 鹵4.49%. The clinical efficacy was evaluated according to the modified Macnab score at 12 months after operation. Among the 19 cases, 11 cases were excellent 57.9% and 8 cases were good, the excellent and good rate was 100. [conclusion] 1.Percutaneous transforaminal discectomy with PELDD was safe for the treatment of juvenile lumbar disc herniation. The long-term effect and recurrence rate of PELD in the treatment of adolescent LDH and its influence on adolescent growth and development still need more clinical observation and further study.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R726.8

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