【摘要】：目的:探討經(jīng)皮內(nèi)鏡下通過(guò)部分椎弓根入路,治療高度向下游離型腰椎間盤突出癥的可行性和安全性,觀察臨床治療效果。方法:選擇2014年7月至2016年1月我院收治的共21例高度向下游離型腰椎間盤突出癥患者(其中L3/4 3例,L4/5 15例,L5/S1 3例),保守治療3周效果不佳。經(jīng)皮脊柱內(nèi)鏡下,磨除部分椎弓根,摘除高度游離的椎間盤髓核組織,解除神經(jīng)根壓迫。統(tǒng)計(jì)手術(shù)時(shí)間和手術(shù)相關(guān)并發(fā)癥。通過(guò)術(shù)前和術(shù)后視覺(jué)模擬評(píng)分(Visual analog scale,VAS)評(píng)分、功能障礙指數(shù)(Oswestry disability index,ODI)評(píng)估患者術(shù)后改善情況,使用改良Macnab療效評(píng)定標(biāo)準(zhǔn)評(píng)估手術(shù)療效。結(jié)果:所有患者均成功實(shí)施手術(shù),手術(shù)時(shí)間93±10min。1例患者術(shù)后第1天出現(xiàn)下肢神經(jīng)感覺(jué)異常,經(jīng)保守治療后癥狀緩解;無(wú)感染、神經(jīng)血管損傷、硬脊膜撕裂等并發(fā)癥出現(xiàn)。隨訪12個(gè)月,VAS術(shù)前7.57±1.09分,術(shù)后1天2.90±0.52分,術(shù)后1月2.24±0.52分,術(shù)后3月1.86±0.63分,術(shù)后6月1.38±0.48分,術(shù)后12月1.19±0.49分,與術(shù)前比較均有顯著性差異(p0.01);ODI評(píng)分由術(shù)前(54.86±12.67)%減少到術(shù)后12月時(shí)(11.80±1.73)%,與術(shù)前比較均有顯著性差異(p0.01)。根據(jù)改良Macnab評(píng)估標(biāo)準(zhǔn),術(shù)后12月時(shí)優(yōu)15例,良4例,可2例,差0例,術(shù)后優(yōu)良率為90.47%。結(jié)論:經(jīng)部分椎弓根入路經(jīng)皮內(nèi)鏡下腰椎間盤切除術(shù)治療高度向下游離型椎間盤突出癥是一種安全、可行、有效的治療方法。
[Abstract]:Objective: to investigate the feasibility and safety of percutaneous endoscopic approach for the treatment of highly downstream lumbar disc herniation through partial pedicle approach. Methods: from July 2014 to January 2016, 21 patients with highly downstream protrusion of lumbar intervertebral disc (L3 / 43, L4 / 5 / 515, L5 / S1, 3 cases) were treated in our hospital. The results of conservative treatment for 3 weeks were not good. Under percutaneous spinal endoscopy, partial pedicle was removed, nucleus pulposus tissue was removed and nerve root compression was relieved. The time of operation and the complications associated with the operation were calculated. Preoperative and postoperative visual analogue score (Visual analog scale( Visual analog), dysfunction index (Oswestry disability) were used to evaluate the postoperative improvement, and modified Macnab evaluation criteria were used to evaluate the outcome of the operation. Results: all the patients were successfully operated. The operation time was 93 鹵10min.1, the first day after operation, the lower extremity nerve sensation was abnormal, the symptoms were relieved after conservative treatment, no infection, nerve and blood vessel injury, dural tear and other complications occurred. VAS was followed up for 12 months (7.57 鹵1.09, 2.90 鹵0.52, 2.24 鹵0.52, 1.86 鹵0.63, 1.38 鹵0.48 and 1.19 鹵0.49, respectively). The ODI scores decreased from (54.86 鹵12.67)% to (11.80 鹵1.73) 12 months after operation (p0.01). According to the modified Macnab evaluation criteria, 15 cases were excellent at 12 months after operation, 4 cases were good, 2 cases were fair, and 0 cases were poor. The excellent and good rate was 90.47%. Conclusion: percutaneous endoscopic lumbar discectomy via partial pedicle approach is a safe, feasible and effective method for the treatment of highly downstream disc herniation.
【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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