【摘要】：[目的]依據游離髓核位置的分型與分區(qū),探討摘除硬膜外游離椎間盤的手術方式并評估經皮內窺鏡下腰椎間盤切除術(PELD)、椎板開窗髓核摘除術(FD)治療硬膜外游離型腰椎間盤突出癥的手術療效。[方法]回顧性分析本科2013年8月~2015年3月收治的此類患者37例,FD組:16例,其中5例髓核游離于1、4區(qū)的患者采用擴大開窗髓核摘除術;11例2、3區(qū)的患者采用常規(guī)FD手術。PELD組:共21例,其中4例髓核游離于1、4區(qū)的患者采用經對側椎間孔鏡腰椎間盤切除術(c-PTED);17例2、3區(qū)的患者應用了常規(guī)的經同側椎間孔鏡腰椎間盤切除術(i-PTED)。采用視覺模擬量表(VAS)評分、改良Macnab分級標準、Oswestry功能障礙指數(ODI)評定手術療效,統(tǒng)計并比較兩組在手術時間、出血量及術后住院時間上的差異。[結果]兩組患者均得到完整隨訪,隨訪時間15~18個月,平均16.3個月。術后下肢疼痛VAS評分及ODI評分均較術前明顯改善(P0.05),但術后兩組間VAS評分及ODI評分差異無統(tǒng)計學意義(P0.05)。依據末次隨訪療效,按照改良Macnab標準評定,PELD組優(yōu)良率95.2%,FD組優(yōu)良率87.5%,差異無統(tǒng)計學意義(P0.05)。PELD組與FD組相比,手術時間較長、出血量少、術后住院時間短,差異有統(tǒng)計學意義(P0.05)。[結論]針對硬膜外游離腰椎間盤突出癥,依據其特有分型與分區(qū)恰當選用i-PTED及c-PTED可實現神經根的徹底減壓,獲得與FD手術相同療效,擴大了PELD治療腰椎間盤突出癥的手術適應證。同時,相對于FD手術,PELD可在局麻下以更加安全、創(chuàng)傷更小的方式摘除游離于硬膜外的椎間盤組織。
[Abstract]:[objective] based on the classification and division of free nucleus pulposus, to explore the surgical method of removing free epidural intervertebral disc and to evaluate the (PELD), of lumbar discectomy under percutaneous endoscope. Surgical efficacy of (FD) in the treatment of epidural free lumbar disc herniation. [methods] A retrospective analysis was made on 37 cases of these patients admitted from August 2013 to March 2015. FD group consisted of 16 patients, 5 of whom were treated with expanded fenestration. 11 patients in area 2 and 3 underwent routine FD operation. PELD group consisted of 21 patients, 4 of whom were treated with contralateral intervertebral foramen endoscope lumbar discectomy (c-PTED), among which 4 patients with nucleus pulposus free in area 1 and 4 were treated with transforaminal lumbar discectomy (c-PTED). 17 patients in area 2 were treated with conventional ipsilateral interforaminal discectomy (i-PTED). Visual analogue scale (VAS), modified Macnab scale and Oswestry dysfunction index (ODI) were used to evaluate the curative effect of the operation. The difference of operation time, blood loss and postoperative hospitalization time between the two groups was analyzed and compared. [results] the patients in both groups were followed up for 15 ~ 18 months with an average of 16.3 months. Postoperative lower limb pain VAS score and ODI score were significantly improved compared with the preoperative (P0.05), but there was no significant difference between the two groups in VAS score and ODI score (P0.05). According to the result of the last follow-up, according to the modified Macnab standard, the excellent and good rate of the PELD group was 95.2% and the excellent and good rate of FD group was 87.5%. There was no significant difference between the two groups (P0.05 compared with the FD group, the operation time was longer and the amount of bleeding was less in the). PELD group. Postoperative hospitalization time was short, the difference was statistically significant (P0.05). [conclusion] in view of epidural free lumbar disc herniation, i-PTED and c-PTED can be used to decompress the nerve root according to its special classification and proper zoning, and the same curative effect can be obtained with FD operation. The surgical indications of PELD for the treatment of lumbar disc herniation were expanded. At the same time, PELD can be removed from the epidural intervertebral disc in a safer and less invasive manner under local anesthesia than with FD.
【作者單位】： 濱州醫(yī)學院附屬醫(yī)院;山東濱州市人民醫(yī)院;
【基金】：山東省醫(yī)藥衛(wèi)生科技發(fā)展計劃項目(編號:2013WS0300)
【分類號】：R687.3

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相關期刊論文 前4條

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本文編號：2415756