| 经皮内镜椎板间入路腰椎间盘髓核摘除术治疗青壮年单节段巨大型腰椎间盘突出症 |
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投稿时间：2024-09-19
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈康 |
CHEN Kang |
自贡市第一人民医院骨科, 四川 自贡 643000 |
Derpartment of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China |
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| 杨富国 |
YANG Fu-guo |
自贡市第一人民医院骨科, 四川 自贡 643000 |
Derpartment of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China |
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| 罗园超 |
LUO Yuan-chao |
自贡市第一人民医院骨科, 四川 自贡 643000 |
Derpartment of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China |
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| 何仁建 |
HE Ren-jian |
自贡市第一人民医院骨科, 四川 自贡 643000 |
Derpartment of Orthopaedics, the First People's Hospital of Zigong, Zigong 643000, Sichuan, China |
herenjian1978@163.com |
| 黄宏杰 |
HUANG Hong-jie |
核工业四一六医院脊柱骨科, 四川 成都 610000 |
Derpartment of Spine Surgery, Nuclear Industry 416 Hospital, Chengdu 610000, Sichuan, China |
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| 期刊信息：《中国骨伤》2024年37卷，第12期，第1173-1179页 |
| DOI：10.12200/j.issn.1003-0034.20240377 |
| 基金项目:自贡市科学技术局重点科技计划项目(编号:2021YLSF01);四川医学会项目(编号:S20057) |
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目的: 探讨经皮内镜椎板间入路腰椎间盘髓核摘除术(percutaneous endoscopic interlaminar discectomy,PEID)治疗单节段巨大型腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效及影像学转归。
方法: 回顾性分析2018年10月至2023年3月采用PEID治疗的31例单节段巨大型LDH 患者的临床资料,男18例,女13例;年龄15~40(28.5±7.4)岁;L4,5 10例,L5S1 21例;左侧14例,右侧17例;病程3~19(6.8±3.1)个月。记录手术时间、出血量、术中透视次数及住院时间等。采用疼痛视觉模拟评分(visual analogue scale,VAS)评估腰痛及腿痛,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评估腰椎功能,末次随访时采用改良MacNnab 标准评价临床疗效。采用椎管正中矢径、椎管有效矢径、椎管面积及硬膜囊面积评估椎管减压情况。比较椎间隙前缘高度、中部高度及后缘高度评估椎间隙变化情况。
结果: 所有患者完成脊柱内镜手术治疗,手术时间30~71(48.7±14.2) min,出血量10~40(21.1±7.0) ml,术中透视次数4~7(4.7±0.7)次。住院时间3~8(5.1±1.3) d,术后随访12~34(16.9±4.1)个月。术前,术后3、6个月及末次随访时,腰痛VAS分别为(6.2±1.8)、(1.4±0.8)、(1.9±0.7)、(1.6±0.6)分;腿痛VAS分别为(7.6±1.6)、(1.8±0.9)、(1.6±0.6)、(1.4±0.7)分;ODI评分分别为(35.74±4.62)、(6.68±1.78)、(6.90±1.85)、(7.10±1.94)分;术后各时间点腰痛、腿痛VAS及ODI均较术前明显改善(P<0.05)。术后6个月腰痛VAS高于术后3个月(P<0.05)。末次随访时按照改良MacNab标准,优14例,良15例,可2例。术前及末次随访时,椎管正中矢径分别为(0.77±0.18)、(1.18±0.24) cm;椎管有效矢径分别为(0.48±0.17)、(0.89±0.23) cm;椎管面积分别为(0.90±0.22)、(1.68±0.43) cm2;硬膜囊面积分别为(0.41±0.10)、(0.81±0.24) cm2;末次随访时椎管正中矢径、椎管有效矢径、椎管面积及硬膜囊面积均较术前显著增加(P<0.05)。术前及末次随访时,椎间隙前缘高度分别为(1.13±0.13)、(0.83±0.11) cm;中部高度分别为(0.81±0.20)、(0.61±0.14) cm;后缘高度分别为(0.67±0.21)、(0.46±0.15) cm;末次随访椎间隙前缘高度、中部高度及后缘高度均较术前减少(P<0.05)。
结论: 采用PEID治疗巨大型LDH,能有效摘除突出巨大髓核组织,同时避免对马尾神经和神经根而发生损伤,具有良好的早期临床效果;但术后椎间隙高度却明显丢失。 |
| [关键词]:腰椎间盘突出症 内镜手术 影像学 |
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| Lumbar disc nucleus pulposus excision by percutaneous endoscopic interlaminar approach for single segment giant lumbar disc herniation in young adults |
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Abstract:
Objective To explore feasibility,clinical and imaging outcomes of percutaneous endoscopic interlaminar discectomy (PEID) for single level large lumbar disc herniation(LDH).
Methods From October 2018 to March 2023,31 patients with single level LDH treated with PEID were retrospectively analyzed. Among patients,including 18 males and 13 females,aged from 15 to 40 years old with an average of (28.5±7.4) years old;L4,5 in 10 patients,L5S1 in 21 patients;14 patients on the left side,17 patients on the right side;the courses of disease ranged from 3 to 19 months with an average of (6.8 ±3.1) months. Operation time,blood loss,fluoroscopy times and hospital stay were observed. Visual analogue scale (VAS) was used to evaluate low back and leg pain,Oswestry disability index (ODI) was used to evaluate lumbar function,modified MacNab was used to evaluate clinical efficacy at the latest follow-up. Median sagittal diameter of spinal canal,effective sagittal diameter of spina canal,spinal canal area,and dural sac area were used to evaluate spinal decompression. Anterior,middle,and posterior heights of intervertebral space were used to evaluate intervertebral space changes.
Results All patients were performed spinal endoscopic surgery,operation time ranged from 30 to 71 min with an average of (48.7±14.2) min,blood loss ranged from 10 to 40 ml with an average of (21.1±7.0) ml,and intraoperative fluoroscopy times ranged from 4 to 7 with an average of (4.7±0.7). The hospital stay ranged from 3 to 8 days with an average of (5.1±1.3) days,and postoperative follow-up ranged from 12 to 34 months with an average of (16.9±4.1) months. VAS of low back pain before operation and 3,6 months after operation,the latest follow-up were (6.2±1.8),(1.4±0.8),(1.9±0.7),(1.6±0.6),respectively;VAS of leg pain were (7.6±1.6),(1.8±0.9),(1.6±0.6),(1.4±0.7),respectively;ODI were (35.74±4.62),(6.68±1.78),(6.90±1.85),(7.10±1.94),respectively;postoperative lower back pain and leg pain VAS and ODI were significantly improved at all time points after operation (P<0.05). Postoperative VAS of low back pain at 6 months was higher than that of 3 months after operation (P<0.05). At the laest follow-up,14 patients were excellent,15 good,and 2 acceptable according to modified MacNab standard. Median diameters of spinal canal were (0.77±0.18) and (1.18±0.24) cm before operation and at the latest follow-up. The effective diameters of spinal canal were (0.48±0.17) and (0.89±0.23) cm,respectively. The vertebral canal areas were (0.90±0.22) and (1.68±0.43) cm2,respectively. Dural sac areas were (0.41±0.10) and (0.81±0.24) cm2,respectively. At the least follow-up,median diameter,effective diameter,area of spinal canal and dural sac were significantly increased compared with those before operation (P<0.05). Anterior vertebral space height before operation was (1.13±0.13) cm,and improved to (0.83±0.11) cm at the latest follow-up. Central height decreased from (0.81±0.20) cm before operation to (0.61±0.14) cm at the latest follow-up. The height of posterior margin decreased from (0.67±0.21) cm before operation to (0.46±0.15) cm at the latest follow-up (P<0.05).
Conclusion PEID for giant LDH could effectively remove protruding giant nucleus pulposus tissue,and avoid injury to cauda equina nerve and nerve roots,which has good early clinical effect. However,the height of intervertebral space was obviously lost after operation. |
| KEYWORDS:Lumbar disc herniation Endoscopic surgery Imaging |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈康,杨富国,罗园超,何仁建,黄宏杰.经皮内镜椎板间入路腰椎间盘髓核摘除术治疗青壮年单节段巨大型腰椎间盘突出症[J].中国骨伤,2024,37(12):1173~1179 |
| 英文格式: | CHEN Kang,YANG Fu-guo,LUO Yuan-chao,HE Ren-jian,HUANG Hong-jie.Lumbar disc nucleus pulposus excision by percutaneous endoscopic interlaminar approach for single segment giant lumbar disc herniation in young adults[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1173~1179 |
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