| 两种不同入路椎间孔镜技术治疗L4，5椎间盘突出症 |
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Received:May 20, 2019
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| 作者 | Author | 单位 | Unit | E-Mail |
| 林海 |
LIN Hai |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 张世民 |
ZHANG Shi-min |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
smzhang1117@163.com |
| 吴冠男 |
WU Guan-nan |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 靳蛟 |
JIN Jiao |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 刘昱彰 |
LIU Yu-zhang |
中国中医科学院望京医院脊柱一科, 北京 100102 |
The First Department of Spinal Surgery, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China |
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| 期刊信息：《中国骨伤》2019年32卷，第10期，第904-909页 |
| DOI：10.3969/j.issn.1003-0034.2019.10.006 |
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目的：分析经椎间孔入路与椎板间入路椎间孔镜技术治疗L4，5椎间盘突出症的临床疗效、适应证、手术要点。
方法：对2016年11月至2018年6月采用椎间孔镜技术治疗L4，5椎间盘突出症的48例患者进行回顾性分析。其中，32例采用经皮内镜椎间孔入路椎间盘切除术（PETD），男17例，女15例，年龄（60.22±16.55）岁，病程（2.18±2.68）月；16例采用经皮内镜椎板间入路椎间盘切除术（PEID），男7例，女9例，年龄（42.25±15.89）岁，病程（2.90±3.02）月。统计分析两组术前、术后3 d、术后3个月、术后6个月时VAS、ODI，并采用改良Macnab标准评估临床疗效。
结果：48例患者顺利完成手术治疗，且均获得随访。两组患者性别、病程、随访时间比较差异无统计学意义（P>0.05）；PETD组年龄（60.22±16.55）岁高于PEID组（42.25±15.89）岁（P<0.05）。PETD组中，高龄患者（70岁以上）10例，非游离型（24例）多于游离型（8例），肩上型（27例）多于腋下型（1例）和腹侧型（4例），5例外侧型和2例极外侧型均采用PETD；而在PEID组中，腋下型（8例）多于肩上型（2例）、腹侧型（6例），4例高位脱垂游离型（Ⅰ区和Ⅳ区）均采用PEID。两组患者术后各随访点腰痛和腿痛VAS评分、ODI均较术前明显改善（P<0.05）。末次随访采用改良Macnab标准对临床疗效进行评价，PETD组优24例，良5例，可2例，差1例；PEID组优12例，良3例，可0例，差1例。
结论：经两种入路椎间孔镜技术治疗L4，5椎间盘突出症均能取得满意疗效，但PETD更适合高龄患者、非游离型、外侧型、极外侧型、肩上型腰椎间盘突出症者；而高位脱垂游离型（Ⅰ区和Ⅳ区）、腋下型腰椎间盘突出者宜选择PEID。 |
| [关键词]:内窥镜 外科手术,微创性 椎板间入路 椎间孔入路 |
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| Treatment of L4,5 lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches |
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Abstract:
Objective:To analyze the clinical efficacy,indications and operative points of transforaminal approach and interlaminar approach in the treatment of L4,5 lumbar disc herniation.
Methods:A retrospective analysis was performed on 48 patients with L4,5 lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy from November 2016 to June 2018. Among them,32 patients underwent percutaneous endoscopic transforaminal discectomy(PETD),including 17 males and 15 females,with an average age of (60.22 ±16.55) years,and the course of disease was(2.18±2.68) months;16 patients underwent percutaneous endoscopic interlaminar discectomy(PEID),including 7 males and 9 females,with an average age of (42.25±15.89) years,and the course of disease was(2.90±3.02) months. VAS,ODI of two groups before operation,3 days,3 months,and 6 months after operation were analyzed,and modified Macnab standard was used to evaluate the clinical effects.
Results:All the 48 patients successfully completed the surgical treatment,and all patients were followed up. There was no significant difference in gender,course of disease and follow-up time between two groups (P>0.05). The age of PETD group was(60.22±16.55) years and PEID group was (42.25±15.89) years,there was statistical difference between two groups (P<0.05). In the PETD group,there were 10 patients with advanced age,non-free type(24 cases) was more than free type(8 cases),and shoulder type(27 cases) more than axillary type(1 case) and ventral type(4 cases). PETD was used in 5 patients with lateral type and 2 patients with extreme lateral type. In PEID group,the axillary type(8 cases) was more than the shoulder type(2 cases) and the ventral type(6 cases),PEID was used in 4 patients with high prolapse free type(ⅠandⅡregions). VAS scores and ODI of patients in two groups at each postoperative follow-up point were significantly improved compared with those before surgery(P<0.05). According to modified Macnab standard to evaluate the clinical effect,in PETD group,24 cases obtained excellent results,5 good,2 fair,1 poor,while in PEID group,12 excellent,3 good,0 fair,1 poor.
Conclusion:Both two surgical approachs can achieve satisfactory efficacy in treating L4,5 lumbar disc herniation,but PETD is more suitable for elderly patients,non-free type,lateral type,extremely lateral type and shoulder type of lumbar disc herniation. High prolapse(ⅠandⅡregions) and axillary type lumbar prominent should select PEID. |
| KEYWORDS:Endoscopes Surgical procedures,minimally invasive Transforaminal approach Interlaminar approach |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 林海,张世民,吴冠男,靳蛟,刘昱彰.两种不同入路椎间孔镜技术治疗L4，5椎间盘突出症[J].中国骨伤,2019,32(10):904~909 |
| 英文格式: | LIN Hai,ZHANG Shi-min,WU Guan-nan,JIN Jiao,LIU Yu-zhang.Treatment of L4,5 lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(10):904~909 |
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