经皮内窥镜下腰椎间盘切除术治疗外侧型腰椎间盘突出症

Percutaneous endoscopic lumbar discectomy for lateral disc herniation

中文关键词:  腰椎间盘突出症  外侧型  内窥镜  后外侧入路

英文关键词:Lumbar disc herniation  Endoscope  Lateral disc herniation  Posterolateral approach

中文摘要:

  【摘要】 目的：探讨腰椎后外侧入路经皮内窥镜下椎间盘切除术治疗外侧型腰椎间盘突出症的手术技术和临床疗效。方法：2006年3月～2007年3月共收治40例外侧型腰椎间盘突出症患者，男25例，女15例，平均年龄35岁（17～63岁），突出节段L5/S1 8例，L4/5 30例，L3/4 2例。采用局部浸润麻醉，C型臂X线透视引导下定位，后外侧入路经皮穿刺进入椎间孔，工作套管逐级扩张，显露突入椎管后外侧的椎间盘组织，在内窥镜直视下行突出髓核组织切除术。采用视觉模拟疼痛评分（visual analogue scale，VAS）和改良MacNab标准评定手术疗效。结果：本组无术中硬脊膜破裂和血管、神经损伤并发症。5例患者术后出现下肢一过性痛觉过敏，经保守治疗1周后症状缓解。平均手术时间70min（40～150min），出血5~20ml，平均术后下床时间36h（24~48h），平均住院时间5d（3～10d）。随访时间12个月，下肢坐骨神经痛VAS评分术前为8.5±1.2分，术后3d时为3.5±1.4分，末次随访时为1.5±1.1分；术前、术后结果进行配对t检验有显著性差异（P<0.01）。MacNab标准临床效果评定结果为优30例，良6例，可4例，优良率90%。结论：经皮内窥镜下椎间盘切除术创伤小、出血少、视野清晰、操作精细、术后恢复快、手术效果优良，是治疗外侧型腰椎间盘突出的优选术式。

英文摘要:

  【Abstract】 Objective：To evaluate the efficacy and surgical technique of percutaneous endoscopic lumbar discectomy（PELD） for lateral disc herniation.Method：Forty patients with lateral disc herniation were subjected to percutaneous endoscopic lumbar discectomy from March 2006 to December 2006.There were 25 males and 15 females with the average age of 35 years（range，17-63 years）.Surgical segments included L5/S1 in 8 cases，L4/5 in 30 cases，L3/4 in 2 cases.All patients were performed under local anesthesia with 1% lidocaine and bupivacaine infiltration.C-arm was used for percutaneous placement of posterolateral needle.After placing the work tube and exposure of herniated nucleus pulposus，the extruded nucleus fragments were pulled through the endoscopic working channel.The modified MacNab criteria and visual analogue scale（VAS） were employed to evaluate the clinical outcome.Result：There were no dural matter tear and intraoperative neurovascular injury.Five patients suffered transient hyperalgia in lower limbs which healed after 1 week of conservative treatment.The mean follow-up period was 12 months.The average operative time was 70 minutes per level.The blood loss was 5-20ml.The bed time was 24-48 hours（average，36h）.The average hospital stay was 5 days（range，3-10 days）.The VAS scores of sciatica decreased from 8.5±1.2 of preoperative to 3.5±1.4 at 3th days postoperative and 1.5±1.1 at 12th months postoperative（P<0.01）.There were 30 excellent，6 good and 4 fair according to MacNab score system with the excellent to good rate of 90%.Conclusion：PELD is applicable for lateral disc herniation，which has the advantages of minimally invasive and early function recovery.