本文選題：經(jīng)皮內(nèi)窺鏡 + 椎板間入路��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：背景及目的經(jīng)皮脊柱內(nèi)鏡椎板間入路椎間盤切除術(shù)治療腰椎間盤突出癥取得了良好的效果,其優(yōu)勢在于局部麻醉下手術(shù),直視下充分暴露神經(jīng)組織完成減壓,未損傷腰椎穩(wěn)定性結(jié)構(gòu),感染和出血少,恢復(fù)較快,該技術(shù)對于特殊類型的腰椎間盤突出癥,例如鈣化型及脫垂游離型腰椎間盤突出癥的治療效果尚不明確。本研究評估了經(jīng)皮脊柱內(nèi)鏡椎板間入路及改良技術(shù)對于鈣化型和脫垂游離型腰椎間盤突出癥的治療效果。第一部分方法:收集了2013年11月至2016年3月在南昌大學(xué)第二附屬醫(yī)院骨科接受經(jīng)皮脊柱內(nèi)鏡椎板間椎間盤切除術(shù)(PEID)的患者的資料。其中20例鈣化型腰椎間盤突出癥患者納入研究組(平均年齡43歲,30-59歲),20例年齡,性別和體重指數(shù)(BMI)與非鈣化型腰椎間盤突出癥相匹配的病例作為對照(平均年齡40歲,22-58歲)。收集圍手術(shù)期數(shù)據(jù)術(shù)前和術(shù)后3、6、12個月視覺模擬評分法(VAS),Oswestry功能障礙指數(shù)(ODI),應(yīng)用改良Mac Nab標(biāo)準(zhǔn)判定療效,通過腰椎CT評價鈣化病灶術(shù)后12個月的變化情況。結(jié)果:兩組40例患者,手術(shù)成功并獲得隨訪。兩組患者性別,年齡,BMI和病變節(jié)段差異無統(tǒng)計學(xué)意義(P0.05)。CLDH組手術(shù)時間明顯長于NCLDH組,差異有統(tǒng)計學(xué)意義(P0.05)。手術(shù)后患者腰痛及下肢疼痛的不適癥狀立即緩解。兩組術(shù)前、術(shù)后VAS和ODI評分差異均有統(tǒng)計學(xué)意義(P0.01),兩組患者VAS評分各時間點差異無統(tǒng)計學(xué)意義(P0.05),但術(shù)后早期NCLDH組VAS評分略好于CLDH組(P0.05),NCLDH組各時間點ODI評分略好于CLDH組,差異無統(tǒng)計學(xué)意義(P0.05)。CLDH組和NCLDH組在最終隨訪中Mac Nab優(yōu)良的結(jié)果百分比分別為90%和95%,組間差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)前及術(shù)后各時間點CLDH組出現(xiàn)感覺異常的患者病歷均多于NCLDH組,差異無統(tǒng)計學(xué)意義(P0.05)。術(shù)后通過腰椎CT的評價,短期內(nèi)椎間盤未再次發(fā)現(xiàn)明顯的鈣化病灶。第二部分方法:2013年11月至2016年3月根據(jù)Lee分級的高度脫垂游離的腰椎間盤突出癥(1-4區(qū))患者15例納入研究,8例男性患者以及7例女性患者(平均年齡41歲,22-56歲),L4/L5間隙5例,L5/S1間隙10例。收集圍手術(shù)期數(shù)據(jù)術(shù)前和術(shù)后3、6、12個月視覺模擬評分法(VAS),Oswestry功能障礙指數(shù)(ODI),應(yīng)用改良Mac Nab標(biāo)準(zhǔn)判定療效。結(jié)果:15例患者順利完成手術(shù),術(shù)后下肢痛均立即消失,無神經(jīng)根損傷、術(shù)后出血及硬膜破裂等并發(fā)癥,手術(shù)時間50-72min平均60min。術(shù)后3、6及12個月VAS評分、ODI指數(shù)與術(shù)前比較均有顯著性差(P0.01),術(shù)后各時間點間比較無顯著性差異(P0.05)。按照Mac Nab評價標(biāo)準(zhǔn),優(yōu)良率93.3%(14/15)。結(jié)論經(jīng)皮脊柱內(nèi)鏡椎板間入路及其改良技術(shù)對于治療特殊類型的腰椎間盤突出癥有良好的臨床療效,特別是對于治療鈣化型及脫垂游離型腰椎間盤突出癥,安全、有效、創(chuàng)傷小,短期內(nèi)臨床療效較好,其遠(yuǎn)期療效還需進(jìn)一步的臨床研究。
[Abstract]:Background and objective Percutaneous endoscopic interlaminectomy for the treatment of lumbar disc herniation has achieved good results, its advantage lies in local anesthesia surgery, full exposure of nerve tissue under direct vision to complete decompression. The effect of this technique on the treatment of special types of lumbar disc herniation such as calcified and prolapsed free lumbar disc herniation is not clear. This study evaluated the efficacy of percutaneous endoscopic interlaminar approach and modified technique in the treatment of calcified and prolapse free lumbar disc herniation. Methods: from November 2013 to March 2016, data were collected from patients undergoing percutaneous endoscopic interlaminectomy of vertebral disc (PEIDD) in the Department of Orthopaedics, second affiliated Hospital of Nanchang University. Twenty patients with calcified lumbar disc herniation (mean age of 43 years, 30 to 59 years old) and non-calcified lumbar disc herniation patients (mean age 40 years, 22 to 58 years old) were included in the study group (mean age, 43 years, 30 to 59 years old) and matched with non-calcified lumbar disc herniation (mean age, 40 years and 22 to 58 years old). The data of perioperative period were collected before and after operation. The visual analogue score was used to evaluate the Oswestry dysfunction index in 12 months. The modified Mac Nab criterion was used to evaluate the curative effect. The changes of calcified lesions were evaluated 12 months after operation by lumbar CT. Results: 40 patients in both groups were operated successfully and followed up. There was no significant difference between the two groups in terms of sex, age and lesion segment. The operative time of the two groups was significantly longer than that of the NCLDH group, and the difference was statistically significant (P 0.05). The symptoms of low back pain and lower extremity pain were relieved immediately after operation. There were significant differences in VAS and ODI scores between the two groups before and after operation (P 0.01). There was no significant difference in VAS scores between the two groups at each time point. However, the VAS score in the early postoperative NCLDH group was slightly better than that in the CLDH group at each time point, and the ODI score was slightly better in the early postoperative NCLDH group than in the CLDH group. There was no significant difference in the percentage of excellent results of Mac Nab between the two groups in the final follow-up (90%) and in the NCLDH group (95%). There was no significant difference between the two groups (P 0.05). The patients with abnormal sensation in CLDH group were more than those in NCLDH group at each time point before and after operation, the difference was not statistically significant (P 0.05). After the lumbar spine CT evaluation, no significant calcification lesions were found in the intervertebral disc in a short period of time. Methods: from November 2013 to March 2016, 15 patients with highly prolapse of lumbar intervertebral disc herniation (zone 1-4) according to the Lee classification were included in the study of 8 male patients and 7 female patients (mean age 41 years, 22 to 56 years old). There were 5 cases of L 5 / S 1 space in 5 cases. The data of perioperative period were collected before and after operation. The visual analogue scoring method was used to evaluate the efficacy of VAS-Oswestry dysfunction index. The modified Mac Nab criterion was used to evaluate the efficacy. Results the operation was successfully completed in 15 cases. The pain of lower extremity disappeared immediately. There were no complications such as nerve root injury, postoperative hemorrhage and dural rupture. The average operation time of 50-72min was 60 minutes. There was significant difference in VAS scores between 3 months and 12 months after operation (P 0.01), but there was no significant difference between different postoperative time points (P 0.05). According to Mac Nab criteria, the excellent and good rate was 93. 3%. Conclusion Percutaneous endoscopic interlaminar approach and its modified technique are safe and effective in the treatment of special types of lumbar disc herniation, especially in the treatment of calcified and prolapsed lumbar disc herniation. Small trauma, short-term clinical effect is better, its long-term effect needs further clinical research.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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本文編號：1975592