经皮内窥镜下手术治疗复发性腰椎盘突出症

Percutaneous transforaminal endoscopic discectomy to manage recurrent lumbar disc herniation

中文关键词:  腰椎间盘突出症  经皮内窥镜下椎间盘切除术  经椎间孔  复发性

英文关键词:Lumbar disc herniation  Percutaneous endoscopic discectomy  Transforaminal  Recurrent

中文摘要:

  【摘要】 目的：总结经皮内窥镜下手术治疗复发性腰椎盘突出症的效果及并发症。方法：2003年12月~2005年12月，共有32例复发性腰椎盘突出症患者纳入研究，男22例，女10例。手术时年龄21~63岁，平均42岁。手术节段：L3/4 7例，L4/5 22例，L5/S1 3例。均采取局部麻醉下经皮侧入路从椎间孔进入内窥镜下手术减压。术后随访患者症状的改善情况。结果：手术时间25~60min，平均40min，2例（6%）发生并发症，1例脊膜破裂，另1例术后出现暂时性小腿外侧麻木。随访24~45个月，平均30个月，使用Macnab标准评估术后疗效，2年随访时优10例，良16例，可3例，差3例，整体满意度81.2%（26/32），6例疗效不满意，其中3例合并节段结构性不稳和1例侧隐窝严重狭窄的患者接受传统减压融合术。VAS由术前平均7.8分减少到末次随访时的2.4分，有明显改善（P＜0.001）。结论：经皮侧入路内窥镜下手术处理复发性腰椎间盘突出症不需处理瘢痕组织，不破坏更多的脊椎结构，手术时间短，并发症少，若无节段结构性不稳定，单纯经皮侧入路内窥镜下减压术是处理复发性椎盘突出的较好方法。

英文摘要:

  【Abstract】 Objective：To investigate a 2-year follow-up outcome and associated complications of percutaneous endoscopic lumbar discectomy for recurrent disc herniation.Method：Thirty-two patients with diagnosis of recurrent lumbar disc herniation undergoing percutaneous endoscopic transforminal lumbar discectomy under local anesthesia were reviewed retrospectively.There were 22 males and 10 females.The levels of recurrence were L3/4 in seven cases，L4/5 in 22 cases and L5/S1 in 3 cases.The mean follow up time was 30 months（range，24-45 months）.Result：The operation time was 25-60min（mean，40min）.Two（6%） cases were complicated with dural matter tear in 1 and transient dysesthesia in 1.According to Macnab criteria，the surgical outcomes were excellent in 10（31.2%） cases，good in 16（50%）cases，fair in 3（9.4%） cases and poor in 3（9.4%） cases. Twenty-six（81.2%） patients got satisfactory result，another 6 cases unsatisfied with outcome returned to conventional decompression and fusion protocol.The preoperative mean VAS was 7.8 which decreased to postoperative mean 2.4 at final follow up（P<0.001）.Conclusion：Percutaneous transforaminal endoscopic discectomy for recurrent lumbar disc herniation has less complication and less operation time for its obviation of dealing with epidural scar tissue and the interference with bony structure.We recommend percutaneous endoscopic transforaminal lumbar discectomy for recurrent lumbar disc herniation on the basis of posterior elements remaining intact.