椎间孔镜治疗腰椎融合内固定术后相邻节段椎间盘突出症

Treatment of Disc Herniation of Adjacent Segments After Lumbar Fusion and Internal Fixation with Percutaneous Endoscopic.

目的探讨椎间孔镜技术治疗腰椎融合内固定术后相邻节段椎间盘突出症的临床应用价值。方法选择我科2017年11月至2019年6月收治的腰椎融合内固定术后邻近节段椎间盘突出症患者20例,用椎间孔镜进行手术治疗,其中椎间孔入路15例,椎板间入路5例。记录手术时间、术中出血量、住院天数。术后1、3、6、12个月进行定期随访复查。采用"视觉模拟评分"(visual analog score, VAS)评估疼痛缓解程度,日常生活能力评定量表(Barthel指数)评估生活质量。结果手术顺利完成,全部病例获得随访。手术时间40~120 min,平均(80.0±5.0)min;手术出血10~20 ml,平均(10±5)ml,术后住院天数3~5 d,平均(4±1)d。所有患者VAS评分较术前明显降低,Barthel指数较术前明显增高,差异有统计学意义(P<0.05)。结论椎间孔镜技术治疗腰椎融合内固定术后相邻节段椎间盘突出症,具有手术创伤小、出血少、时间短、住院天数少、费用低、术后恢复快等优点,是较好的一种手术方案。

Objective To explore values of percutaneous endoscopic technology to treat adjacent segment disc herniation after lumbar fusion and internal fixation.Methods From November 2017 to June 2019,20 patients of lumbar disc herniation after lumbar fusion and internal fixation were selected.Operation was performed with percutaneous endoscopic,15 cases were through intervertebral foramen and 5 cases were through lamina.Operation time,bleeding volume and hospitalization days were recorded.1,3,6 and 12 months after operation,patients were followed up regularly.Visual analog score(VAS)was used to assess degree of pain relief,and Barthel index was used to assess the quality of life.Results Operation was successfully completed,and all cases were followed up.Mean time of operation was 40~120 mins,average was(80.0±5.0)mins,surgical bleeding was 10~20 ml,average was(10±5)ml,postoperative hospitalization was 3~5 days,average(4±1)days.VAS score was significantly lower than that before operation,and Barthel index was significantly higher than that before operation(P<0.05).Conclusion Percutaneous endoscopic treatment of lumbar disc herniation at the adjacent segment after fusion and internal fixation has advantages of small surgical trauma,less bleeding,short time,less days in hospital,low cost and quick postoperative recovery,which would be a better surgical scheme.