| 杨傲飞,王鑫,连小峰,等.日间手术模式下运用椎间孔镜精准靶向治疗L5/S1巨大型腰椎间盘突出症的治疗体会.骨科,2022,13(1): 41-46. |
| 日间手术模式下运用椎间孔镜精准靶向治疗L5/S1巨大型腰椎间盘突出症的治疗体会 |
| Percutaneous Transforaminal Endoscopic Lumbar Surgery for L5/S1 Lumbar Disc Herniation in Day Surgery Mode |
| 投稿时间：2021-07-13 |
| DOI：10.3969/j.issn.1674-8573.2022.01.010 |
| 中文关键词: 日间手术 椎间孔镜 腰椎间盘突出症 |
| 英文关键词: Day surgery Transforaminal endoscopic Lumbar disc herniation |
| 基金项目:国家自然科学基金项目（81272001）；湖北省卫生健康委资助项目（ZY2021Q014）；“武汉中青年医学骨干人才”资助项目（201987） |
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| 中文摘要: |
| 目的 在日间手术（day surgery，DS）运行模式下，采用经皮椎间孔镜技术进行精准靶向定位并摘除L5/S1脱出的巨大椎间盘，探讨其手术技巧以及临床疗效。方法 回顾性分析2018年4月至2020年3月上海市第六人民医院和湖北省中医院运用经皮椎间孔镜技术治疗的121例L5/S1巨大椎间盘脱出病人的临床资料，其中男82例，女39例，年龄为16~65岁，平均41.2岁。记录术中透视次数、建立通道时间以及手术时间，统计术前、术后3、6、12个月及末次随访的疼痛视觉模拟量表（visual analogue scale，VAS）评分以及Oswestry功能障碍指数（Oswestry disability index，ODI）。采用改良MacNab评分评价优良率。结果 病人术中X线透视次数为8~15次，平均为10次；自穿刺开始至通道建立所用的时间为5~10 min，平均7.3 min；放置椎间孔镜后至手术操作结束的时间为15~45 min，平均为26.4 min。VAS评分从术前的（8.42±1.33）分降至末次随访的（0.95±0.54）分，ODI指数从术前的（32.48±8.82）%降至末次随访的（8.43±0.97）%，差异均有统计学意义（P均＜0.05）。末次随访时改良MacNab评分，优97例，良19例，可4例，差1例，优良率为95.87%。结论 对于L5/S1的巨大椎间盘脱出病人，在DS模式管理下，采用局部麻醉下的精准靶向椎间孔镜技术治疗，获得了满意的临床疗效，值得在临床中进一步推广。 |
| 英文摘要: |
| Objective In the operation mode of day surgery, using percutaneous transforaminal endoscopic lumbar surgery to accurately target positioning and smoothly remove the huge lumbar disc herniation of L5/S1, and to explore its surgical techniques and clinical effects. Methods The clinical data of 121 cases of L5/S1 huge lumbar disc herniation treated with percutaneous transforaminal endoscopy lumbar surgery were retrospectively analyzed in Shanghai Sixth People's Hospital and Hubei Provincial Hospital of Traditional Chinese Medicine from April 2018 to March 2020. There were 82 males and 39 females, aged from 16 to 65 years, with an average of 41.2 years. The number of intraoperative fluoroscopy, channel establishment time and operation time were recorded. The visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, 3, 6 and 12 months after operation and at the last follow-up were statistically analyzed. The modified MacNab score was used to evaluate the excellent and good rate. Results The number of intraoperative X-ray fluoroscopy was 8-15 times, with an average of 10 times. The time from the start of the puncture to the establishment of the channel was 5-10 min, with an average of 7.3 min. The time from the placement of the foraminal lens to the end of the operation was 15 to 45 min, with an average of 26.4 min. The VAS score decreased from (8.42±1.33) points before surgery to (0.95±0.54) points at the last follow-up after surgery, and ODI decreased from (32.48±8.82) % before surgery to (8.43±0.97) % at the last follow-up after surgery, with the difference being statistically significant (P＜0.05). Using the modified MacNab score, efficacy was excellent in 97 cases, good in 19 cases, fair in 4 cases, and poor in 1 case. The excellent and good rate was 95.87%. Conclusion For L5/S1 patients with huge lumbar disc herniation, under the management of day surgery mode, the precise targeted percutaneous transforaminal endoscopic lumbar surgery under local anesthesia has achieved satisfactory clinical effects and is worthy of further promotion in the clinic. |
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