| 经皮椎间孔镜椎间盘切除术治疗高位腰椎间盘突出症 |
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投稿时间：2012-05-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 何升华 |
HE Sheng-hua |
芜湖市中医医院骨科,安徽 芜湖 241000 |
Department of Orthopaedics,Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,Anhui,China |
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| 赵祥 |
ZHAO Xiang |
芜湖市中医医院骨科,安徽 芜湖 241000 |
Department of Orthopaedics,Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,Anhui,China |
zhxtiggcr@163.com |
| 吴小海 |
WU Xiao-hai |
芜湖市中医医院骨科,安徽 芜湖 241000 |
Department of Orthopaedics,Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,Anhui,China |
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| 丁浩 |
DING Hao |
芜湖市中医医院骨科,安徽 芜湖 241000 |
Department of Orthopaedics,Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,Anhui,China |
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| 方俊 |
FANG Jun |
芜湖市中医医院骨科,安徽 芜湖 241000 |
Department of Orthopaedics,Wuhu Hospital of Traditional Chinese Medicine,Wuhu 241000,Anhui,China |
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| 期刊信息：《中国骨伤》2012年，第25卷，第11期，第920-922页 |
| DOI：10.3969/j.issn.1003-0034.2012.11.010 |
| 基金项目: |
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中文摘要:
目的：评价经皮椎间孔镜腰椎间盘切除术治疗经保守治疗无效的高位腰椎间盘突出症临床效果.
方法：2008年12月至2011年6月,收治12例经保守治疗无效的高位腰椎间盘突出症患者.其中男8例,女4例;年龄28～82岁,平均50.67岁;病程3～10个月,平均5.75个月.突出节段：T12L1 1例,L1,2 1例,L2,3 3例,L3,4 7例,其中合并L4,5间盘退变6例,合并L5S1间盘退变2例.12例责任椎间盘退变分级均为Ⅲ级.经椎间盘造影证实椎间盘后方纤维环均撕裂,行经皮椎间孔镜腰椎间盘切除术治疗.于术前、术后行疼痛视觉模拟评分(visual analogue scale,VAS),术前、术后末次随访行Oswestry功能障碍指数(Oswestry disability index,ODI)评定,按改良Macnab标准评价临床疗效.
结果：手术时间1.0～2.5 h,平均1.45 h;术后住院时间4～9 d,平均5.83 d.12例均获随访,时间1～12个月,平均5.5个月.术中未发生脑脊液漏、脊髓神经损伤.术前VAS评分为(8.00±1.21)分,术后为(1.92±0.79)分,与术前比较差异有统计学意义(P<0.01).术前ODI评分为(78.81±13.65)%,末次随访为(16.19±3.52)%,与术前比较差异有统计学意义(P<0.01).根据改良Macnab标准：优3例,良8例,可1例.
结论：经皮椎间孔镜腰椎间盘切除术治疗经保守治疗无效的高位腰椎间盘突出症是一有益的尝试,患者术后疗效较佳,但需注意与L3,4以下椎间盘突出症治疗的不同. |
| 【关键词】椎间盘移位 腰椎 外科手术 |
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| Percutaneous endoscpic lumbar discectomy for the treatment of upper lumbar disc herniation |
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ABSTRACT
Objective:To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with upper lumbar disc herniation and failing to respond to conservative treatment.
Methods:From December 2008 to June 2011,12 patients with upper lumbar disc herniation and failing to respond to conservative treatment were treated,including 8 males and 4 females,aged from 28 to 82 years old (averaged,50.67 years old). Duration of upper lumbar disc herniation was 3 to 10 months,with an average of 5.75 months. MRI exam revealed 12 “degeneration discs” low in signal on T2 image,including 1 discs of T12L1,1 of L1,2 ,3 of L2,3 and 7 of L3,4. Discography showed positive response,fluoroscopy confirmed annulus fibrosus tears of posterior intervertebral disc in 12 discs. PELD was performed. Visual analogue scale (VAS) and Oswestry disability index(ODI) were evaluated before operation and after operation. The clinical outcome was determined by modified Macnab criteria at the final follow-up.
Results:The average operation time of each patient was 1.45 h (ranged,1.0 to 2.5 h),and the mean length of postoperative hospital stay was 5.83 days (ranged,4 to 9 days). There was no happening in ruptured meninges and nerve damage. Twelve patients were followed up,and the duration ranged from 1 to 12 months (averaged,5.5 months). The VAS score decreased from preoperative 8.00±1.21 to postoperative 1.92±0.79(P<0.01). The ODI decreased from preoperative (78.81±13.65)% to the final follow-up (16.19±3.52)% (P<0.01). According to the modified Macnab criteria,3 patients got an excellent result,8 good,1 fair.
Conclusion:PELD is effective in treating patient with upper lumbar disc herniation failing to respond to conservative treatment. |
| KEY WORDS Intervertebral disc displacement Lumbar vertebrae Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 何升华,赵祥,吴小海,丁浩,方俊.经皮椎间孔镜椎间盘切除术治疗高位腰椎间盘突出症[J].中国骨伤,2012,25(11):920~922 |
| 英文格式: | HE Sheng-hua,ZHAO Xiang,WU Xiao-hai,DING Hao,FANG Jun.Percutaneous endoscpic lumbar discectomy for the treatment of upper lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(11):920~922 |
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