椎间孔镜下髓核摘除术治疗青少年型腰椎间盘突出症

Percutaneous endoscopic lumbar discectomy for adolescent lumbar disc herniation

目的探讨椎间孔镜下髓核摘除术治疗青少年型腰椎间盘突出症的临床效果。方法 2008年11月-2012年4月,解放军总医院微创脊柱外科中心共收治18岁以下腰椎间盘突出症患者18例,其中男性11例,女性7例。年龄14~18岁,平均15.9岁。比较术前、术后特定时间点腰痛疼痛视觉模拟法（visual analogue scale,VAS）评分、腿痛VAS评分及Oswestry功能障碍指数（oswestry disability index,ODI）。通过术后末次随访时的Macnab评分对临床疗效进行评价。结果手术时间为30~65 min,平均45 min;手术出血量为3~10 ml,平均5 ml;手术切口长度6~8 mm,平均7 mm;无感染、血管及神经损伤等手术并发症发生。所有患者均获得随访,时间为33~75个月,平均54.5个月。患者腰痛VAS评分从术前（5.22±1.06）分降至术后末次随访（0.67±0.77）分（P〈0.05）;腿痛VAS评分从术前（7.78±0.73）分降至术后末次随访（0.78±0.55）分（P〈0.05）;ODI从术前（65.6±7.24）降至术后末次随访（3.50±3.12）分（P〈0.05）。按照脊柱Macnab评分标准,术后末次随访时,优15例,良3例。结论椎间孔镜下髓核摘除术治疗青少年型腰椎间盘突出症安全有效。

Objective To investigate the clinical efficacy of percutaneous endoscopic lumbar discectomy（PELD） for adolescent lumbar disc herniation. Methods Medical records of 18 adolescent patients with LDH（lumbar disc herniation） from November 2008 to April 2012 in Chinese PLA General Hospital, including 11 males and 7 females, with an average age of 15.9 years old（14-18 years old）, were retrospectively reviewed. The clinical signs and radiographic materials were evaluated before surgery. The visual analog scale（VAS） scores for low back pain and leg pain, Oswestry Disability Index（ODI） scores were recorded and compared at the follow time points： before surgery, 1 day, 1 month, 6 months, 1 year after operation. The clinical outcomes at the final follow-up were assessed by modified Macnab criteria. Results The average operation duration was 45 min（ranged from 30 min to 65 min）, the mean length of incision was 7 mm（ranged from 6 mm to 8 mm）, and the mean intraoperative blood loss was 5 ml（ranged from 3 ml to 10 ml）. No complication such as infection or neurovascular injury occurred. The average follow-up duration was 54.5 months ranging from 33-76 months. The VAS score of low back pain was 5.22±1.06 points preoperatively, which reduced to 0.67±0.77 points at the latest follow-up（P 〈0.05）.The VAS score of leg pain was 7.78±0.73 points preoperatively, which reduced to 0.78±0.55 points at the latest follow-up（P 〈0.05）. The ODI score was 65.6±7.24 points preoperatively, which reduced to 3.50±3.12 points at the latest follow-up（P 〈0.05）. At the last follow-up, the scores of the modified Macnab criteria were excellent in 15 patients and good in 3 patients. Conclusion PELD is safe and effective, which provides a new choice for adolescent lumbar disc herniation.