巨大型腰椎椎间盘突出症的微创外科治疗

Minimally invasive treatment for lumbar disc herniation with massive extrusion

目的探讨巨大型腰椎椎间盘突出症微创手术策略。方法 2007年1月～2010年10月,对86例巨大型腰椎椎间盘突出症患者采用微创外科手术治疗。其中,椎间孔内镜椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)28例,显微内镜椎间盘切除术(microendoscopic discectomy,MED)35例,微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,miTLIF)23例。术前与术后疼痛视觉模拟量表(visual analog scale,VAS)评分和改良Macnab标准评价临床疗效。结果 3种微创术式均能显著改善患肢放射性疼痛VAS评分。术后优良率都在85%以上。PELD术适于年轻人巨大型腰椎椎间盘突出症;MED术适于巨大型腰椎椎间盘突出症伴椎管狭窄;miTLIF术适于伴有腰椎退行性失稳或伴有马尾综合征或术后复发的巨大型腰椎椎间盘突出症。结论临床上应依据巨大型腰椎椎间盘突出症的不同类型,选择不同微创外科术式。

Objective To discuss minimally invasive strategies for lumbar disc herniation with massive extrusion. Meth ods From January 2007 to October 2010, 86 patients with lumbar disc herniation with massive extrusion were treated with minimally invasive techniques, including 28 cases for percutaneous endoscopic lumbar discectomy （ PELD）, 35 cases for microendoscopic discectomy （MED）, and 23 cases for minimally invasive transforaminal lumbar interbody fusion （miTLIF）. Clinical outcomes were assessed by visual analog scale （VAS） scores and a modified Macnab＇ s criteria at pre and post operation. Results All of the 3 sorts of procedures could significantly improve the radiating leg symptoms. The postoperative overall excellent and good rate for 3 techniques were all above 85%. The PELD technique was suitable for young patients of simple type lumbar disc herniation with massive extrusion ; the MED technique was specially suitable for lumbar disc herniation with massive extrusion combined with lumbar canal stenosis; and the miTLIF was designed for lumbar disc herniation with massive extrusion combined with degenerative lumbar instability and/or canda equina syndrome. Conclusion Minimally invasive strategies and options should be determined by different types of lumbar disc herniation with massive extrusion.