经皮椎间孔镜治疗腰椎椎体后缘骺环离断症的近期疗效

Short-term Effectiveness of Percutaneous Endoscopic Lumbar Discectomy for Treatment of Lumbar Posterior Ring Apophysis Fracture

目的探讨经皮椎间孔镜治疗腰椎椎体后缘骺环离断症(posterior ring apophysis fracture,PRAF)的近期疗效。方法 2016年10月~2017年2月我科对19例腰椎PRAF采用Joimax经皮椎间孔镜技术治疗,经侧方入路进入椎管建立工作通道,经工作通道切除椎体后缘漂浮的骺环组织,并进行责任神经根的减压和松解。采用腰、腿痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及改良MacNab标准评估近期疗效。结果 19例术后患肢直腿抬高试验阴性。19例随访6~9个月,腰、腿痛VAS评分和ODI术后24 h、1个月、6个月与术前比较差异均有统计学意义(P均<0.05)。腰痛VAS评分术后24 h、1个月、6个月两两比较差异均无统计学意义(P均>0.05);腿痛VAS评分、ODI术后24 h与术后6个月比较有统计学意义(P均<0.05),术后1个月与术后24 h和6个月比较均无统计学意义(P均>0.05)。术后6个月改良MacNab标准评估疗效,12例优,6例良,1例可,优良率94.7%(18/19)。结论经皮椎间孔镜治疗腰椎PRAF近期疗效优良,具有减少手术创伤、康复快、保护腰椎正常组织结构及运动功能等优势。

Objective To explore the short-term efficacy of percutaneous endoscopic lumbar discectomy for treatment of lumbar posterior ring apophysis fracture（ PRAF）. Methods Between October 2016 and February 2017,19 patients with lumbar PRAF were treated by Joimax percutaneous endoscopic lumbar discectomy. A working tunnel into the vertebral canal was established via the lateral approach. The epiphyseal ring attached at the posterior margin of vertebral body was cut off,followed by decompression and release of the nerve root. The short-term cured effect was evaluated by using Visual Anologue Score（ VAS） of low back pain and leg pain,Oswestry disability index（ ODI） and modified MacNab criteria. Results The straight-leg raising test showed negative results in the 19 cases. All the patients were followed up for 6-9 months. The VAS scores of low back pain and leg pain and ODI had significant differences between preoperation and 24 hours,1 month and 6 months after operation（ P〈0. 05）. The VAS scores of lower back pain at 24 hours,1 month and 6 months after operation were not significantly different between each other（ P〉0. 05）. The VAS scores of lower back pain and ODI had significant differences between 24 hours after operation and 6 months after operation（ P〈0. 05）and had no significant difference between 1 month and 6 months after operation（ P〉0. 05）. According to the modified MacNab criteria,the results were excellent in 12 cases,good in 6 cases,and fair in 1 case,the excellent and good rate being 94. 7%（ 18/19）.Conclusion Percutaneous endoscopic lumbar discectomy for treatment of lumbar PRAF has advantages of excellent short-term efficaey,mild operational trauma,short recovery time and small lumbar structure damage.