经皮椎间盘旋切治疗腰间盘突出症1282例疗效分析

The Analysis of the Curative Effect on Percutaneous Diskectomy in the Treatment of Lumbar Disc Protrusion in 1282 Cases

目的探讨经皮椎间盘旋切治疗腰椎间盘突出症的疗效及影响因素。方法对1282例患者1912个椎间盘,其中有3例3个失败,实际手术1909个椎间盘进行回顾性地分析。结果手术成功率99.5%;显效率79.7%(1022/1282);有效率15.3%(196/1282);无效率4.8%(61/1282)。总有效率为95%。结论侧隐窝狭窄、病变椎间隙狭窄及突出的髓核钙化可作为相对适应证,“椎间盘手术史”不应作为绝对禁忌证;包容型椎间盘突出治疗效果好;对疑有运动神经纤维不可逆性损伤者,不宜行PLD;对外伤后出现较重症状的年轻患者,施行PLD应慎重;髓核摘除量越多,疗效越好。

Objective:To eveluate the therapeutic effect and related factors of percutaneous lumbar diskectomy (PLD) on lumbar disc protrusion. Methods:1912 lumbar disc protrusion in 1282 cases treated by PLD in this series, among 3 disc in 3 cases were failure. The retrospective analyses were taken as follows.Results:The successful rate was 99.5%;the curative and effective rates were 79.7% and 15.3% respectively. The overall effective rate was 95%.Conclusions:The stenosis of the lateral recess and the intervertebral space & the disc with calcification might possibly be treated with PLD; 'the history of operation on the lumbar disc' were not absolute contraindication;The therapeutic effect of the contained lumbar disc protrusion was good;having irreversible motor nerve paralysis was contraindication;The PLD to young patient who had injured and had severe symptom must be cautious;The more amount of disc tissue removed, the more the therapeutic effect. But the better therapeutic effect were obtained on the part cases of the annulus fibrosus being trepanned and then the pressure of disc was decreased.