摘要
目的观察单侧椎间孔入路经皮内窥镜椎间盘切除术(PETD)治疗伴双侧神经根症状巨大腰椎间盘突出症(LDH)的临床疗效。方法回顾性分析2014年6月至2017年12月陆军军医大学新桥医院收治的38例伴双侧神经根压迫的巨大单节段LDH患者的临床资料。患者均采用单侧PETD治疗。记录手术前后腰痛及下肢痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)和日本骨科学会(JOA)评分,观察术中、术后并发症发生情况。结果所有患者均成功施术。平均手术时间(77.8±11.6)min,平均术中出血量(6.5±1.5)mL;无切口及椎间隙感染、神经损伤并发症发生。随访时间24~38个月,平均随访时间(27.8±3.9)个月。患者术后7 d、随访24个月时下肢痛和腰痛VAS评分、ODI和JOA评分均较术前改善,手术前后比较,差异有统计学意义(P<0.05)。末次随访时3例患者(8%)因手术节段复发LDH而再次手术。结论单侧PETD技术安全有效,是治疗伴双侧神经根症状巨大LDH的较好选择。但在神经根充分减压时需尽量保留纤维环、后纵韧带等组织的完整性,避免术后复发。
Objective To observe the clinical effect of unilateral percutaneous endoscopic transforaminal discectomy(PETD)in treatment of massive lumbar disc herniation(LDH)with bilateral nerve root symptoms.Methods Clinical data of 38 patients with single segment massive LDH accompanied with bilateral nerve root symptoms,who treated in Xinqiao Hospital of Army Medical University from June 2014 to December 2017 were analyzed retrospectively.All patients underwent unilateral PETD.Visual analogue scale(VAS)scores of low back and lower extremity pain,Oswestry disability index(ODI)and Japanese Orthopaedic Association(JOA)score were recorded before and after operation,and intraoperative and postoperative complications were observed.Results Patients underwent surgery successfully,with average operation time of(77.8±11.6)min,and average estimate intraoperative blood loss of(6.5±1.5)mL.No surgical incision infection,intervertebral space infection or nerve injury occurred.The average follow-up time was(27.8±3.9)months(24 to 38 months).At 7 d postoperatively and 24 months'follow-up,VAS scores of lwo back and lower extremity pain,as well as ODI and JOA score all improved compared with preoperative ones,there were statistical differences between preoperation and postoperation(P<0.05).At the latest follow-up,3 patients(8%)received a second operation because of the recurrence of LDH.Conclusions Unilateral PETD is safe and effective,which is a good choice in the treatment of massive LDH with bilateral nerve root symptoms.The integrity of annulus fibrosus,posterior longitudinal ligament and other relative tissues should be preserved as far as possible to avoid postoperative recurrence when attempt to adequately decompress the nerve root.
作者
王洪岗
刘超
郑文杰
WANG Honggang;LIU Chao;ZHENG Wenjie(Department of Orthopaedics Surgery,75130 Military Hospital,Guigang,Guangxi Zhuang Autonomous Region 537100,China;不详)
出处
《中国骨科临床与基础研究杂志》
2020年第2期69-73,共5页
Chinese Orthopaedic Journal of Clinical and Basic Research
基金
中国博士后基金面上项目(2018M643892)。
关键词
腰椎
椎间盘移位
椎间孔镜
椎间盘切除术
经皮
单侧手术
Lumbar vertebrae
Intervertebral disc displacement
Transforaminal endoscopy
Diskectomy
percutaneous
Unilateral surgery