| 段小锋,金伟,陈俊君,等.经皮椎间孔镜下椎间盘摘除术的临床应用分析与技巧探讨.骨科,2016,7(1): 17-21. |
| 经皮椎间孔镜下椎间盘摘除术的临床应用分析与技巧探讨 |
| Clinical analysis and skills of percutaneous endoscopic lumbar discectomy |
| 投稿时间：2015-04-16 |
| DOI：10.3969/j.issn.1674-8573.2016.01.005 |
| 中文关键词: 内窥镜 腰椎 外科手术，微创性 椎间盘切除术 |
| 英文关键词: Endoscope Lumbar vertebrae Surgical procedures, minimally invasive Discectomy |
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| 中文摘要: |
| 目的 研究经皮椎间孔镜下椎间盘摘除术（percutaneous endoscopic lumbar discectomy, PELD）治疗腰椎间盘突出症的临床疗效、并发症及手术技巧。方法 回顾性分析2012年10月至2014年10月于我院接受PELD治疗重度腰椎间盘突出症的197例患者的临床资料。评价患者术前、术后3个月和术后1年的疼痛视觉模拟量表（visual analogue scale, VAS）评分及Oswestry功能障碍指数（Oswestry disability index，ODI），并进行比较；采用Macnab评价标准评定临床治疗效果。结果 本组患者的手术时间为50~85 min，平均65 min：出血量为10~50 ml，平均20 ml；住院时间为5~7 d。4例患者术后改行开放手术。术后随访12~20个月，平均14.7个月。术后3个月和1年时的VAS评分、ODI与术前相比均有明显改善，差异有统计学意义（VAS：t=57.89，P=0.000；t=60.54，P=0.000；ODI：t=48.30，P=0.000；t=48.04，P=0.000）；而且术后1年的VAS评分和ODI较术后3个月时亦有改善，差异有统计学意义（t=14.89，P=0.000；t=11.64，P=0.000）。术后3个月的Macnab评价结果：优151例，良31例，可11例，优良率为94.3％（182/193）；术后1年时的Macnab评价：优155例，良30例，可8例，优良率为95.9％（185/193）。结论 PELD治疗腰椎间盘突出症具有创伤小、恢复快、疗效好、并发症低的优点，易被患者接受。 |
| 英文摘要: |
| Objective To study the clinical effectiveness, complications and surgical procedures of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of lumbar intervertebral disc protrusion. Methods From October 2012 to October 2014, the clinical data of 197 patients with severe lumbar intervertebral disc protrusion receiving PELD in our hospital were retrospectively analyzed. The visual analogue scale (VAS) scores and Oswestry disability index (ODI) were assessed before and at 3rd month and 1st year after operation and compared. The Macnab evaluation criteria were used to assess the clinical therapeutic effect. Results The surgical procedures were performed successfully on all 197 patients. The operative time was 50-85 min (mean 65 min), blood loss was 10-50 ml (mean 20 ml), hospital stay was 5-7 days, and postoperative follow-up period was 12-20 months (mean 14.7 months). Four patients were converted to open surgery. At 3rd month and 1st year after operation, the VAS scores and ODI were significantly increased as compared with those preoperation (t=57.89, P=0.000; t=60.54, P=0.000; t=48.30, P=0.000; t=48.04, P=0.000). There was significant difference in VAS scores between postoperative 1st year and postoperative 3rd month (t=14.89, P=0.000; t=11.64, P=0.000). For Macnab evaluation results, at postoperative 3rd month, 151 cases obtained excellent outcome, 31 good, 11 fair with the effective rate being 94.3%; at postoperative 1st year, 155 cases obtained excellent outcome, 30 good, and 8 fair with the effective rate being 95.9%. Conclusion PELD in the treatment of lumbar intervertebral disc protrusion has the advantages of rapid recovery, minimal trauma, satisfactory curative effect, and low incidence of postoperative complications. |
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