本文選題：巨大腰椎間盤突出 + 經(jīng)皮內(nèi)鏡下腰椎間盤髓核摘除術(shù)��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討經(jīng)皮內(nèi)鏡下腰椎間盤髓核摘除術(shù)(Percutaneous endoscopic lumbar discectomy,PELD)聯(lián)合微創(chuàng)通道PEEK半剛性固定棒非融合固定技術(shù)治療巨大腰椎間盤突出(Huge lumbar disc herniation,HLDH)的可行性、安全性及初步臨床療效。方法:納入2014年6月--2015年10月HLDH患者共21例,并全部給予PELD聯(lián)合微創(chuàng)通道PEEK半剛性固定棒非融合固定術(shù)治療。術(shù)前及術(shù)后各時(shí)間點(diǎn)的腰腿和腿痛視覺模擬評(píng)分(Visual analog scale,VAS)被記錄,術(shù)前及末次隨訪Oswestry功能障礙指數(shù)評(píng)分(Oswestry disability index,ODI)、末次改良Mac Nab療效評(píng)定標(biāo)準(zhǔn)被記錄。結(jié)果:21例患者均全部成功完成手術(shù)。平均手術(shù)時(shí)間為189.8±50.6min。平均術(shù)中失血量為102.4±88.7 ml。平均住院時(shí)間為9±3.1 d。隨訪7月~22月,平均13±4.1月。與術(shù)前相較,術(shù)后3月、6月及末次腰痛VAS評(píng)分改善明顯。與術(shù)前相較,術(shù)后第1天、1月、3月、6月及末次腿痛VAS評(píng)分改善明顯。與術(shù)前相較,術(shù)后第1天腰痛VAS評(píng)分有所增加。與術(shù)前相較,術(shù)后1月腰痛VAS評(píng)分統(tǒng)計(jì)學(xué)下無明顯差異。與術(shù)前相較,末次隨訪ODI評(píng)分較術(shù)前有明顯改善。末次改良Mac Nab療效評(píng)定標(biāo)準(zhǔn):優(yōu)18例,良2例,可1例。末次隨訪時(shí)無患者復(fù)發(fā)。結(jié)論:通過對(duì)PELD聯(lián)合微創(chuàng)通道PEEK半剛性固定棒非融合固定術(shù)治療HLDH的初步分析,該手術(shù)在技術(shù)上是安全可行的,有著令人滿意的短期臨床療效。但由于隨訪時(shí)間偏短且缺少與傳統(tǒng)標(biāo)準(zhǔn)融合固定等手術(shù)方式的對(duì)比,該技術(shù)遠(yuǎn)期療效有待更進(jìn)一步的深入的研究。
[Abstract]:Objective: to investigate the feasibility, safety and preliminary clinical effect of percutaneous endoscopic discectomy of endoscopic lumbar discectomyn (PELDD) combined with minimally invasive channel PEEK semi-rigid rod nonfusion fixation in the treatment of giant lumbar disc herniation. Methods: a total of 21 patients with HLDH from June 2014 to October 2015 were enrolled and all were treated with PELD combined with minimally invasive channel PEEK semi-rigid fixed rod non-fusion fixation. Visual analog scale was recorded at all time points before and after operation. Oswestry disability index was evaluated before and at the last follow-up, and the last modified Mac Nab evaluation standard was recorded. Results all 21 cases were successfully operated. The mean operative time was 189.8 鹵50.6 min. The average intraoperative blood loss was 102.4 鹵88.7 ml. The average hospitalization time was 9 鹵3.1 days. The follow-up ranged from 7 months to 22 months, with an average of 13 鹵4.1 months. Compared with preoperative, the VAS scores of 3 months, 6 months and the last time of low back pain improved significantly. The VAS scores of leg pain on the first day, one month, three months, six months and the last time after operation were significantly improved compared with those before operation. Compared with preoperative, the VAS score of low back pain increased on the first day after operation. There was no significant difference in VAS score of low back pain between before and after operation. The ODI score of the last follow-up was significantly improved compared with that before operation. The last modified Mac Nab evaluation criteria were excellent in 18 cases, good in 2 cases and fair in 1 case. No recurrence occurred at the last follow-up. Conclusion: through the preliminary analysis of PELD combined with minimally invasive PEEK semi-rigid fixed rod non-fusion fixation for HLDH, the operation is technically safe and feasible, and has a satisfactory short-term clinical effect. However, due to the short follow-up time and the lack of comparison with the traditional standard fusion and fixation, the long-term effect of this technique needs further in-depth study.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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