经皮对侧椎间孔入路内窥镜下椎间盘切除术治疗游离型腰椎间盘突出症

Percutaneous endoscopic lumbar discectomy for migrated lumbar disc herniation via contralateral transforaminal approach

中文关键词:  腰椎间盘突出症  经皮内窥镜下腰椎间盘切除术  游离型  经对侧椎间孔入路

英文关键词:Lumbar disc herniations  Percutaneous endoscopic lumbar discectomy  Migrated  Contralateral

中文摘要:

  【摘要】 目的：探讨经皮对侧椎间孔入路内窥镜下腰椎间盘切除术（percutaneous endoscopic lumbar discecto?鄄my，PELD）治疗游离型腰椎间盘突出症的可行性及安全性。方法：2010年2月～2012年2月采用经对侧椎间孔入路PELD治疗游离型腰椎间盘突出症患者12例，均为单节段椎间盘突出，其中L3/4 3例，L4/5 9例，观察患者术中情况及手术耐受性，记录手术时间及术后并发症。通过术前和术后下肢放射痛VAS评分、功能障碍指数（Oswestry disability index，ODI）评估患者术后改善情况，使用改良Macnab疗效评定标准评估手术疗效。结果：12例患者均顺利完成手术，术中患者耐受性好，手术时间110±20min。1例术后马尾神经损伤症状加重，保守治疗3个月后症状缓解，余病例无神经、血管、硬膜囊损伤等并发症发生。随访12～24个月，平均18±2.5个月，下肢放射痛及日常生活功能均有明显改善，术后下肢放射痛VAS评分由术前7.75±0.97分减少到术后第一天的2.42±0.79分，末次随访时为1.42±0.79分，与术前比较均有显著性差异（P<0.0001）；OID评分由术前57.67±9.57减少到末次随访时的8.50±3.73，差异有显著性（P<0.0001）。末次随访时改良Macnab疗效评定优8例，良3例，可1例，优良率为91.67%（11/12）。结论：经对侧椎间孔入路PELD治疗游离型腰椎间盘突出症是一种安全、可行的手术方法。

英文摘要:

  【Abstract】 Objectives: To investigate the safety and feasibility of percutaneous endoscopic lumbar discectomy(PELD) via contralateral transforaminal approach. Methods： From February 2010 to February 2012, 12 patients suffering from migrated lumbar disc herniation were treated by this method. 3 patients were at L3/4 and 9 patients were at L4/5. Patients′ intraoperative response and tolerance were observed. Operation time and postoperative complications were recorded. Patients′ radicular pain and daily life function were evaluated by the visual analog scale(VAS) and Oswestry disability index(ODI) scores. Outcomes were graded by modified Macnab criteria. Results: All the patients tolerated the operation without special complaints. Mean operation time was 110±20mins. One patient had the symptom of coccygeal nerve injury deteriorated after operation, which relieved after 3-month conservative treatment. The rest patients presented with no neurological, vascular or dural injury. Patients were followed up for 12-24 months, mean follow-up time was 18±2.5 months. Mean VAS score improved from 7.75±0.97 at preoperation to 2.42±0.79 at the first day of postoperation, and to 1.42±0.79 at last follow-up, which showed significant differences compared with the preoprative. Mean ODI score improved from 57.67±9.57 at preoperation to 8.50±3.73 at last follow-up, which also showed significant differences. Radicular pain and daily life function improved obviously. Excellent was noted in 8 patients, good in 3 patients, fair in 1 patient, with the satisfactory rate of 91.67%(11/12). Conclusions: PELD via contralateral transforaminal approach is safe and feasible for migrated lumbar disc herniation.