椎间盘造影术在椎间孔镜治疗多间隙腰椎间盘突出症的诊治价值研究

Discography in Percutaneous Endoscopic Lumbar Discectomy Treatment of Multiple Lumbar Disc Herniation

目的探讨椎间盘造影术在椎间孔镜治疗腰椎间盘突出症的临床价值,为临床治疗腰椎间盘突出症提供新的思路。方法 2013-10/2015-02月间共收治诊断为多间隙腰椎间盘突出症的患者31例,并接受椎间孔镜手术治疗,女性13例,男性18例;年龄23~55岁,平均40岁;其中L_(3~4)并L_(4~5)突出者9例,L_(3~4)并L_5~S_1突出者5例,L_(4~5)并L_5~S_1突出者15例,L_(2~3_并L_5~S_1突出者1例,L_(2~3)、L_(3~4)并L_5~S_1突出者1例;所有患者术中均经椎间盘造影术,造影阳性者行该节段椎间孔镜手术治疗。采用视觉模拟评分法(visual analogue scale,VAS)及改良MacNab标准评估手术疗效。结果 31例患者共行63次椎间盘穿刺造影,单间隙阳性者16例,双间隙阳性者15例,三间隙阳性者0例,共行46个节段的椎间孔镜手术治疗,所有手术均顺利完成;手术时间70~155 min,平均113 min;出血7~25 ml,平均出血量约15ml,所有患者随访12~44个月,平均25.5个月;术后3d VAS评分(2.81±0.72)分、术后3个月(1.15±0.52)分、术后12个月(1.21±0.69)分与术前VAS评分为(6.25±1.03)分比较均有统计学差异(P<0.01);术后3、12个月与术后3 d VAS评分相比有统计学差异(P<0.01);术后12个月与术后3个月VAS评分无统计学差异(P>0.05),疗效优良率为93.5%。结论椎间盘造影术结合椎间孔镜治疗多间隙腰椎间盘突出症具有确切的疗效,为临床治疗腰椎间盘突出症提供了新的思路。

Objective To discuss the discographgs clinical value in the percutaneous endoscopic lumbar discectomy （PELD） treatment of lumbar disc herniation, provide new ideas on clinical treatment of lumbar disc herniation. Methods From October 2013 to February 2015, 31 patients were diagnosed and treated with PELD surgery, there were 13 females and 18 males,aged 23-55 years, mean 40 years, while L3-4 and L4-5 protruding in 9 cases, L3-4 and L5-S1 protruding in 5 cases, L4-5 and L5 -S1 protruding in 15 cases, L2-3 and L5 -S1 protruding in 1 case,L2-3, L3-4 and L5-S1 protruding in 1 case. All patients were confirmed by discography, the segments of positive symptoms accepted PELD surgery. Using visual analogue scale （VAS） and modified MacNab criteria for therapeutic effect evaluation. Results Thirty-one patients conducted a total of 63 times disc puncture angiography, 16 cases were single-gap positive, 15 cases were double gap posi- tive, no one was three gap positive, 46 segments implemented PELD surgery, all patients were successfully completed. Operation time were 70-155 minutes, average 113 minutes, bleeding 7-25 ml, average blood loss was 15 ml, all patients were followed up for 12-44 months, an average of 25.5 months. Postoperative VAS scores at 3 days, 3, 12 months with preoperative VAS score were significantly different （P〈0. 01）, 3, 12 months VAS scores after surgery and postoperative VAS scores at 3 days were significantly different （P〈0. 01 ）, 12 months VAS score had no significant difference with 3 months VAS score （P〉0. 05）, the excellent and good rate was 93. 55%. Conclusion Discography combined PELD treat- ment of multiple lumbar disc herniation has a curative effect, and provide a new way of thinking on the clinical treatment of lumbar disc herniation.