经皮内镜下腰椎间盘切除术治疗巨大型腰椎间盘突出症

Percutaneous endoscopic lumbar discectomy for the treatment of massive lumbar disc herniation

目的探究经皮内镜下腰椎间盘切除术治疗巨大型腰椎间盘突出症的临床疗效及技术特点。方法回顾性分析2016年6月至2018年1月行经皮内镜下腰椎间盘切除术治疗的101例巨大型腰椎间盘突出症患者的临床资料,观察手术前后患者下肢痛及腰痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)变化,记录随访期间并发症发生情况。结果101例患者中99例减压彻底,2例因减压不充分改行微创通道下经椎间孔腰椎椎间融合术。手术时间(68±14)min,术中出血量(20±5)mL,住院时间(4.5±1.5)d。术后下肢痛及腰痛VAS评分、ODI均较术前明显降低(P<0.05)。平均随访26个月(14~32个月)。患者未有神经损伤、硬膜撕裂脑脊液漏、腹膜后血肿并发症;5例出现下肢麻木症状,其中3例术后1个月症状消失,2例末次随访时麻木症状减轻,但仍有残留;末次随访时9例患者再次出现下腰痛症状,其中6例合并下肢痛,复查MRI确定为术后复发,行二次手术后症状缓解;余3例保守治疗后症状减轻。结论经皮内镜下腰椎间盘切除术治疗巨大型腰椎间盘突出症安全可靠,疗效显著。

Objective To investigate the clinical outcomes and the technical characteristics of percutaneous endoscopic lumbar discectomy(PELD)for the treatment of massive lumbar disc herniation(MLDH).Methods Clinical data of 101 patients with MLDH who underwent PELD from June 2016 to January 2018 were retrospectively analyzed.Before and after the surgery,Oswestry disability index(ODI)and visual analogue scale(VAS)score of back pain and leg pain of patients were observed,complications during the follow-up were recorded.Results Of 101 patients,complete decompression was found in 99 patients,the other 2 patients underwent minimal invasive transforaminal lumbar interbody fusion due to the incomplete decompression.The operation time was(68±14)min,intraoperative estimate blood loss was(20±5)mL,hospital stay was(4.5±1.5)d.VAS score of lower limb pain and back pain,as well as ODI all decreased after the operation(P<0.05).Patients were followed up for 26 months(14 to 32 months).No complications of nerve injuries,cerebrospinal fluid leakage due to dural laceration,retroperitoneal hematoma had happened.Lower limb numbness was found in 5 cases,while 1 month later,it disappeared in 3 patients,and the symptom was alleviated but still remained in 2 patients at the last follow-up.Nine patients complained about the low back pain at the latest follow-up.Six of them,who combined with lower limb pain,were confirmed to have recurrence herniation by MRI and treated by a second operation;The other 3 patients were conservatively treated,and the symptom was relieved.Conclusion PELD is safe,reliable and effective for the treatment of MLDH.