| 经皮椎间孔入路内镜下治疗腰椎融合术后邻椎腰椎间盘突出症 |
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投稿时间：2021-10-21
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| 作者 | Author | 单位 | Address | E-Mail |
| 楼超 |
LOU Chao |
丽水市中心医院脊柱外科, 浙江 丽水 323000 |
Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China |
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| 俞伟杨 |
YU Wei-yang |
丽水市中心医院脊柱外科, 浙江 丽水 323000 |
Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China |
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| 陈剑 |
CHEN Jian |
丽水市中心医院脊柱外科, 浙江 丽水 323000 |
Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China |
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| 何登伟 |
HE Deng-wei |
丽水市中心医院脊柱外科, 浙江 丽水 323000 |
Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China |
hedw120@163.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第5期，第448-453页 |
| DOI：10.12200/j.issn.1003-0034.2022.05.008 |
| 基金项目:丽水市公益性技术应用研究项目(编号:2020GYX21) |
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中文摘要:
目的:探讨经皮椎间孔入路内镜下治疗腰椎融合术后邻椎腰椎间盘突出症的临床疗效。
方法:对2010年2月至2018年6月收治的64例腰椎融合术后邻椎腰椎间盘突出症患者进行回顾性分析,分为观察组与对照组。观察组33例中男23例,女10例;年龄55~83(65.7±7.4)岁;单节段融合27例,双节段融合6例;运用经皮椎间孔入路内镜下手术治疗。对照组31例中男22例,女9例;年龄51~78(64.8±7.8)岁;单节段融合25例,双节段融合6例;运用开放融合翻修手术治疗。比较两组患者的手术时间、术中出血量、透视次数、术后下床活动时间和住院时间。采用疼痛视觉模拟评分(visual analgue scale,VAS),Oswestry功能障碍指数 (Oswestry Disability Index,ODI)评估临床疗效。观察两组并发症发生情况。
结果:64例患者均获得至少2年随访,观察组随访时间(2.4±0.5)年,对照组随访时间(2.6±0.7)年。观察组的手术时间、术中出血量、术后下床活动时间、住院时间较对照组明显减少(P<0.05),观察组的透视次数较对照组明显增加(P<0.05)。两组患者腰痛、下肢痛VAS和ODI在末次随访时和术前比较均有明显改善(P<0.05);观察组术后各时间点腰痛VAS,术后1、3个月ODI均较对照组有优势(P<0.05),而两组间下肢痛VAS比较差异无统计学意义(P>0.05)。观察组并发症发生率明显低于对照组(P<0.05)。
结论:与传统再次开放融合翻修术相比,经皮椎间孔入路内镜下微创手术治疗腰椎融合术后邻椎腰椎间盘突出症具有减少手术时间和术中出血量,缩短下床活动时间和住院时间,促进疼痛和功能改善的优点,且可降低并发症发生率。但其中远期的临床疗效有待进一步研究。 |
| 【关键词】椎间盘移位 腰椎 内窥镜检查 脊柱融合术 |
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| Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion |
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ABSTRACT
Objective: To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion.
Methods: From February 2010 to June 2018,64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group,there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy,including 27 cases of single segment fusion and 6 cases of double segment fusion,aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group,there were 22 males and 9 females performed with traditional open fusion revision,including 25 cases of single-segment fusion and 6 cases of double segment fusion,aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time,intraoperative blood loss,fluoroscopy times,postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed.
Results: All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group,operation time,intraoperative blood loss,postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (P<0.05),and the fluoroscopy times of observation group were significantly increased compared with control group(P<0.05). The VAS of low back and lower limb,and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (P<0.05). The VAS of low back at each point and ODI at 1,3 months after operation in observation group was significantly reduced compared with control group(P<0.05),however there was no significant difference in VAS for lower limb between two groups (P>0.05). The difference of complications between two groups was statistically significant (P<0.05).
Conclusion: Compared with traditional open fusion revision surgery,percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss,shortening ambulation time and the length of postoperative hospital stay,and promoting pain and functional improvement,and decrease incidence of complications. However,long-term clinical efficacy needs further study. |
| KEY WORDS Intervertebral disk displacement Lumbar vertebrae Endoscopy Spinal fusion |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 楼超,俞伟杨,陈剑,何登伟.经皮椎间孔入路内镜下治疗腰椎融合术后邻椎腰椎间盘突出症[J].中国骨伤,2022,35(5):448~453 |
| 英文格式: | LOU Chao,YU Wei-yang,CHEN Jian,HE Deng-wei.Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(5):448~453 |
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