目的 探讨经皮椎间孔镜辅助下治疗腰椎间盘突出症伴椎体后缘离断的可行性和临床疗效。方法 回顾性分析2018-01至2020-12在解放军联勤保障部队第910医院脊柱外科采用经皮椎间孔镜经椎间孔入路手术治疗的63例腰椎间盘突出症伴腰椎后缘离断青年官兵临床资料,其中L3-4节段21例,L4-5节段42例。术后随访根据MacNab评分标准评定,比较患者的术前与末次Oswestry功能障碍指数(ODI)、腰部疼痛视觉模拟量表(VAS)评分差异。结果 63例随访时间6~14个月,平均(11.8±1.4)个月。末次随访疼痛VAS平均为(0.9±0.3)分;ODI指数为14%~28%,平均(19.7±3.8)%,均较术前显著改善,差异有统计学意义(P<0.05)。随访疗效采用MacNab评分标准评定:优56例,良6例,差1例,优良率98.4%。结论 经皮椎间孔镜辅助下治疗腰椎间盘突出伴椎体后缘离断的安全性好,术后康复快。
Abstract
Objective To investigate the feasibility and clinical effect of percutaneous foraminoscope assisted lower foraminal approach of lumbar disc herniation with posterior vertebral margin disarticulation.Methods A total of 63 patients with lumbar disc herniation with posterior lumbar spine margin dissociation treated by percutaneous transforaminal approach from January 2018 to December 2020, including 21 patients at L3-4 segment and 42 patients at L4-5 segment, were retrospectively reviewed. Postoperative follow-up was evaluated according to MacNab scoring standard. The scores of patients' preoperative and final Oswestry disability index (ODI) and visual analog scale (VAS) of lumbar pain were compared.Results Sixty-three patients were followed for 6-14 months with a mean follow-up time of (11.8±1.4) months. The pain VAS score at the last follow-up was 0-2, with a mean of (0.9±0.3) points; the ODI index was 14% - 28% with a mean (19.7±3.8)% of the patients, and all the scores were significantly improved compared with those before operation, with statistical significance (P<0.05). The follow-up effect was evaluated by MacNab scoring standard: excellent in 56 cases, good in 6 cases, poor in 1 case, and the excellent and good rate was 98.4%.Conclusions Percutaneous foraminal approach assisted by endoscope is safe to treat lumbar disc herniation with vertebral posterior margin disconnection, and patients can recover quickly after surgery, which is worthy of further research and promotion.
关键词
腰椎间盘突出 /
椎体后缘离断 /
椎间孔镜技术 /
椎间孔入路 /
髓核及离断骨块摘除
Key words
lumbar disc herniation /
vertebral body posterior border disconnection /
foraminoscopic technique /
foraminal access /
removal of nucleus pulposus and isolated bone blocks
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基金
福建省泉州市科技计划项目(2018Z138,2017Z024)
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