經(jīng)皮椎間孔鏡TESSYS技術(shù)治療鈣化型腰椎間盤突出癥療效分析
發(fā)布時(shí)間：2018-08-22 10:57
【摘要】：目的腰椎間盤突出癥(lumber disc herniation)是由于腰椎間盤退變,纖維環(huán)破裂,髓核突出刺激或壓迫神經(jīng)根、馬尾神經(jīng)所表現(xiàn)出來的一系列臨床癥狀和體征,是引起患者腰腿痛的主要原因。根據(jù)腰椎間盤突出的部位,可將腰椎間盤突出癥分為三種類型,即中央型突出、后外側(cè)型突出及椎間孔型突出；根據(jù)現(xiàn)代影像學(xué)檢查,可將其分為膨出、突出、脫出和游離型。腰椎間盤突出癥患者大多可經(jīng)保守治療緩解,然而,仍約有10%-20%的患者經(jīng)保守治療效果不理想,不能有效的緩解疼痛。尤其是伴鈣化的腰椎間盤突出癥患者,這一類型的腰椎間盤突出癥不光指髓核或纖維環(huán)的鈣化,還可累及到黃韌帶、后縱韌帶,壓迫神經(jīng)從而造成患者腰及相應(yīng)節(jié)段所支配區(qū)域疼痛等癥狀。傳統(tǒng)微創(chuàng)手術(shù)對(duì)此類患者效果欠佳,并且不宜行牽引及大的推拿,以免造成嚴(yán)重后果,加重病情。醫(yī)學(xué)上傳統(tǒng)觀點(diǎn)認(rèn)為這種鈣化型椎間盤突出癥需要做開窗手術(shù),否則很難見效。但開窗手術(shù)創(chuàng)傷大、出血多,術(shù)后恢復(fù)時(shí)間長(zhǎng),術(shù)后常伴發(fā)腰椎不穩(wěn)的風(fēng)險(xiǎn),嚴(yán)重影響患者生活質(zhì)量。隨著醫(yī)療設(shè)備技術(shù)的發(fā)展與進(jìn)步,脊柱微創(chuàng)手術(shù)被廣泛應(yīng)用于臨床,較傳統(tǒng)的開窗手術(shù)相比,脊柱微創(chuàng)手術(shù)具有創(chuàng)傷小、不良反應(yīng)少、安全性高、目標(biāo)直接、術(shù)后病人恢復(fù)迅速等優(yōu)點(diǎn)。經(jīng)皮椎間孔內(nèi)鏡TESSYS (transforaminal endoscopic spine system)技術(shù),應(yīng)用廣泛,可用于很多種不同類型腰椎間盤突出癥的治療,譬如突出型、脫出型、游離型等,纖維環(huán)、髓核、骨性椎管狹窄、椎間孔狹窄、黃韌帶肥厚等。然而,目前該技術(shù)治療伴鈣化型腰椎間盤突出癥效果的研究非常少。因此,本研究通過對(duì)比分析不同患者通過椎間孔鏡下TESSYS技術(shù)術(shù)后(3 d、1個(gè)月、3個(gè)月、6個(gè)月)治療效果來探討該技術(shù)治療伴鈣化型腰椎間盤突出癥的療效,以便該技術(shù)更好的應(yīng)用于臨床治療,具有重要的臨床意義。方法 自2014.2月至2014.9月,我科對(duì)伴鈣化型腰椎間盤突出癥患者48例行經(jīng)后外側(cè)入路椎間孔鏡下TESSYS技術(shù)手術(shù)治療,對(duì)每個(gè)病人都通過電話的方式進(jìn)行了為期6個(gè)月的術(shù)后隨訪,分別比較術(shù)前、術(shù)后即刻、術(shù)后3 d、1個(gè)月、3個(gè)月、6個(gè)月的VAS、JOA、Oswestry功能障礙指數(shù)(ODI),最后一次電話隨訪評(píng)定患者的手術(shù)療效時(shí),應(yīng)用改良的MacNab標(biāo)準(zhǔn)進(jìn)行評(píng)定。結(jié)果本組48例患者,手術(shù)成功并獲得隨訪,在48例患者中1例因術(shù)后未遵照醫(yī)囑嚴(yán)格臥床3 d,導(dǎo)致髓核再次脫出,遂再進(jìn)行第2次手術(shù),手術(shù)順利；1例因同時(shí)患有終板炎,術(shù)后下肢放射性疼痛減輕,但仍感腰部疼痛較重,于術(shù)后第7日行椎間盤內(nèi)注射三氧,手術(shù)順利。其余患者手術(shù)均一次性順利完成。48例患者手術(shù)后各時(shí)點(diǎn)與手術(shù)前相比,VAS評(píng)分、JOA評(píng)分均顯著下降,Oswestry評(píng)分顯著升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后6個(gè)月與術(shù)后即刻、3d、1個(gè)月、3個(gè)月相比,VAS評(píng)分顯著下降,JOA評(píng)分明顯下降,Oswestry評(píng)分明顯升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后3個(gè)月與術(shù)后即刻、3d、1個(gè)月相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后1個(gè)月與術(shù)后即刻、3d相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后3d與術(shù)后即刻相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。說明椎間孔鏡治療鈣化型腰椎間盤突出癥有效,且術(shù)后6月效果較好。末次隨訪應(yīng)用改良MacNab標(biāo)準(zhǔn)評(píng)價(jià)患者的臨床療效,21例(43.75%),良23例(47.91%),可4例(8.34%),差0例,優(yōu)良率91.47%(44/48)。結(jié)論經(jīng)皮椎間孔鏡下TESSYS技術(shù)治療伴鈣化型腰椎間盤突出癥安全、有效、創(chuàng)傷小、不良反應(yīng)少,且術(shù)后6個(gè)月效果較好。
[Abstract]:Objective Lumbar disc herniation is a series of clinical symptoms and signs caused by degeneration of lumbar intervertebral disc, rupture of annulus fibrosus, protrusion of nucleus pulposus stimulating or compressing nerve root and cauda equina nerve, which is the main cause of low back and leg pain. There are three types of lumbar disc herniation: central herniation, posterolateral herniation and intervertebral foramen herniation. According to modern imaging examination, it can be divided into herniation, protrusion, prolapse and free type. Pain. Especially in patients with calcified lumbar disc herniation, this type of lumbar disc herniation not only refers to nucleus pulposus or annulus fibrosus calcification, but also involves ligamentum flavum, posterior longitudinal ligament, compression of nerves, resulting in the patient's lumbar and corresponding segmental areas of pain and other symptoms. Traditional minimally invasive surgery for such patients is not effective, and not. Traditionally, this calcified disc herniation requires fenestration, otherwise it is difficult to achieve results. However, fenestration surgery is traumatic, bleeding, postoperative recovery time is long, often accompanied by the risk of lumbar instability, seriously affecting the quality of life of patients. With the development and progress of medical equipment technology, spinal minimally invasive surgery is widely used in clinic. Compared with traditional fenestration surgery, spinal minimally invasive surgery has the advantages of less trauma, fewer adverse reactions, high safety, direct target and rapid recovery. It is widely used in the treatment of many different types of lumbar disc herniation, such as herniation, prolapse, dissociation, annulus fibrosus, nucleus pulposus, osseous spinal canal stenosis, intervertebral foramen stenosis, ligamentum flavum hypertrophy, etc. However, there are very few studies on the effect of this technique in the treatment of calcified lumbar disc herniation. To analyze the therapeutic effect of TESSYS on different patients with calcified lumbar intervertebral disc herniation after operation (3 days, 1 month, 3 months, 6 months) by foraminoscope, so as to better apply the technique to clinical treatment, which has important clinical significance. Methods From February 2014 to September 2014, our department treated the patients with calcified lumbar intervertebral disc herniation. Forty-eight patients with disc herniation underwent TESSYS via posterolateral approach. Each patient was followed up by telephone for 6 months. VAS, JOA, Oswestry Dysfunction Index (ODI) were compared preoperatively, immediately after surgery, 3 days, 1 month, 3 months and 6 months after surgery, and the final telephone follow-up was evaluated. Results Forty-eight patients were successfully operated on and followed up. Among them, one patient failed to follow the doctor's instructions and stayed in bed for 3 days after operation, resulting in the nucleus pulposus prolapse again. The second operation was performed successfully. One patient suffered from endplate inflammation and postoperative radiation pain of lower extremity. The rest of the patients completed the operation smoothly at one time. VAS and JOA scores of 48 patients decreased significantly at each time point after operation, while Oswestry scores increased significantly (P 0.05). VAS score decreased significantly, JOA score decreased significantly, Oswestry score increased significantly (P 0.05) immediately after surgery, 3 days, 1 month, compared with 3 months after surgery, there was no significant difference (P 0.05); 1 month after surgery, compared with immediately after surgery, 3 days, 1 month after surgery, there was no significant difference (P 0.05); There was no significant difference between the latter three days and the immediate postoperatively (P 0.05). The results showed that the treatment of calcified lumbar disc herniation with intervertebral foraminoscopy was effective and effective 6 months after operation. At the last follow-up, 21 cases (43.75%), 23 cases (47.91%) were good, 4 cases (8.34%) were fair, 0 cases were poor, and the excellent and good rate was 91.47% (44/48). TESSYS is a safe, effective, minimally invasive and safe technique for the treatment of lumbar disc herniation with calcification.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
[Abstract]:Objective Lumbar disc herniation is a series of clinical symptoms and signs caused by degeneration of lumbar intervertebral disc, rupture of annulus fibrosus, protrusion of nucleus pulposus stimulating or compressing nerve root and cauda equina nerve, which is the main cause of low back and leg pain. There are three types of lumbar disc herniation: central herniation, posterolateral herniation and intervertebral foramen herniation. According to modern imaging examination, it can be divided into herniation, protrusion, prolapse and free type. Pain. Especially in patients with calcified lumbar disc herniation, this type of lumbar disc herniation not only refers to nucleus pulposus or annulus fibrosus calcification, but also involves ligamentum flavum, posterior longitudinal ligament, compression of nerves, resulting in the patient's lumbar and corresponding segmental areas of pain and other symptoms. Traditional minimally invasive surgery for such patients is not effective, and not. Traditionally, this calcified disc herniation requires fenestration, otherwise it is difficult to achieve results. However, fenestration surgery is traumatic, bleeding, postoperative recovery time is long, often accompanied by the risk of lumbar instability, seriously affecting the quality of life of patients. With the development and progress of medical equipment technology, spinal minimally invasive surgery is widely used in clinic. Compared with traditional fenestration surgery, spinal minimally invasive surgery has the advantages of less trauma, fewer adverse reactions, high safety, direct target and rapid recovery. It is widely used in the treatment of many different types of lumbar disc herniation, such as herniation, prolapse, dissociation, annulus fibrosus, nucleus pulposus, osseous spinal canal stenosis, intervertebral foramen stenosis, ligamentum flavum hypertrophy, etc. However, there are very few studies on the effect of this technique in the treatment of calcified lumbar disc herniation. To analyze the therapeutic effect of TESSYS on different patients with calcified lumbar intervertebral disc herniation after operation (3 days, 1 month, 3 months, 6 months) by foraminoscope, so as to better apply the technique to clinical treatment, which has important clinical significance. Methods From February 2014 to September 2014, our department treated the patients with calcified lumbar intervertebral disc herniation. Forty-eight patients with disc herniation underwent TESSYS via posterolateral approach. Each patient was followed up by telephone for 6 months. VAS, JOA, Oswestry Dysfunction Index (ODI) were compared preoperatively, immediately after surgery, 3 days, 1 month, 3 months and 6 months after surgery, and the final telephone follow-up was evaluated. Results Forty-eight patients were successfully operated on and followed up. Among them, one patient failed to follow the doctor's instructions and stayed in bed for 3 days after operation, resulting in the nucleus pulposus prolapse again. The second operation was performed successfully. One patient suffered from endplate inflammation and postoperative radiation pain of lower extremity. The rest of the patients completed the operation smoothly at one time. VAS and JOA scores of 48 patients decreased significantly at each time point after operation, while Oswestry scores increased significantly (P 0.05). VAS score decreased significantly, JOA score decreased significantly, Oswestry score increased significantly (P 0.05) immediately after surgery, 3 days, 1 month, compared with 3 months after surgery, there was no significant difference (P 0.05); 1 month after surgery, compared with immediately after surgery, 3 days, 1 month after surgery, there was no significant difference (P 0.05); There was no significant difference between the latter three days and the immediate postoperatively (P 0.05). The results showed that the treatment of calcified lumbar disc herniation with intervertebral foraminoscopy was effective and effective 6 months after operation. At the last follow-up, 21 cases (43.75%), 23 cases (47.91%) were good, 4 cases (8.34%) were fair, 0 cases were poor, and the excellent and good rate was 91.47% (44/48). TESSYS is a safe, effective, minimally invasive and safe technique for the treatment of lumbar disc herniation with calcification.
【學(xué)位授予單位】：濱州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
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相關(guān)期刊論文 前10條
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