经椎间孔入路经皮内窥镜下椎间盘切除术治疗钙化型腰椎椎间盘突出症

Percutaneous endoscopic transforaminal discectomy for treatment of calcified intervertebral lumbar disc herniation

目的探讨经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)治疗钙化型腰椎椎间盘突出症的临床疗效。方法回顾性分析本院2013年9月—2014年9月收治的20例钙化型腰椎椎间盘突出症患者的临床资料,所有患者行PETD并钙化物取出,其中L_5/S_1节段4例,L_4/L_5节段16例。所有患者术前均行腰椎CT和MRI检查,根据钙化物的形态和位置进行分型,对突出物与行走神经根的位置关系进行分型,根据不同的分型,采取不同的手术策略。采用疼痛视觉模拟量表(VAS)评分和Mac Nab标准对疗效进行评价。结果所有手术顺利完成,患者随访>3个月。术后复查腰椎CT示症状侧旁中央及神经根管部位的钙化物被完全切除,中央部及无症状侧仍残留部分钙化物。所有患者术后腰腿痛的VAS评分为0~1分,术后Mac Nab标准评价为优。结论 PETD避免过度牵拉神经根,可降低术中发生神经损伤的概率,可切除神经根管处的钙化物有效缓解患者症状,治疗钙化型腰椎椎间盘突出症安全、有效。

Objective To investigate the postoperative clinical results of calcified intervertebral disc herniation treated by percutaneous endoscopic transforaminal discectomy(PETD). Methods From September 2013 to September 2014,the clinical data of 20 patients(L_5/S_1 4 and L_4/L_5 16) with calcified lumbar intervertebral disc herniation underwent PETD and calcified tissue removal were retrospectively analyzed. Lumbar CT and MRI were performed before and after the surgery. The surgical approach was determined based on the different shape,position of the herniation and the relationship between herniation and traversing nerve root. Preoperative and postoperative clinical status were analyzed by visual analogue scale(VAS) score and Mac Nab criteria. Results All the operations were performed successfully. The patients were followed up for more than 3 months. The postoperative lumbar CT showed calcification at the paracentral position and nerve root was fully resected on the symptomatic side. The calcification at the center or the asymptomatic position remained partially. The spinal nerve root canal was decompressed. The postoperative VAS score for leg and back pain was 0-1,and the evaluation was excellent based on Mac Nab criteria. Conclusion PETD avoids excessive traction of nerve roots,reduces the probability of intraoperative nerve injury,and can remove the calcification at the nerve root canal. It can also effectively relieve the symptoms of patients,and is safe and effective for the treatment of calcified lumbar disc herniation.