经皮椎板间入路内窥镜手术治疗腰椎间盘突出症的并发症及应对策略

Complications and coping strategies of percutaneous interlaminar endoscopic surgery for lumbar disc herniation

目的探究经皮内窥镜下椎板间入路髓核摘除术(percutaneous endoscopic interlaminar discectomy,PEID)治疗腰椎间盘突出症的并发症,并分析其原因和处理对策。方法回顾性分析本科于2018年3月~2020年3月开展的122例PEID手术患者,均为L_(5)-S_(1)节段椎间盘突出症,男70例,女52例;年龄29~72岁,平均(42.9±11.3)岁;病程7~23个月,平均(11.2±3.1)个月;突出类型:中央型突出41例,旁中央型81例。术后获访1年,对患者术前和术后VAS评分和术后1年的总体疗效进行评定;统计术后并发症情况,分析其原因和处理对策。结果所有患者均完成PEID手术,与术前相比,术后1年的VAS评分显著降低,差异有统计学意义[术后1年(2.18±0.52)vs.术前(7.26±1.83);t=44.841,P<0.001];术后1年采用改良MacNab标准评价疗效:优57例,良50例,中8例,差7例,优良率87.7%。术后发生14例并发症,发生率11.48%,包括神经根损伤1例,髓核残留3例,腹膜后血肿1例,椎间隙感染2例,术后感觉异常6例,脑脊液漏1例;上述并发症均经对症处理或翻修手术后康复。术后随访1年,5例(4.1%)患者再次复发,其中4例接受显微镜手术、1例接受腰椎融合术后康复。结论PEID手术治疗L_(5)-S_(1)节段椎间盘突出症,总体疗效较好,可显著改善腰腿痛症状,术后早期疗效稳定,总体并发症发生率不高,有临床应用价值。

Objective To explore the complications of percutaneous endoscopic interlaminar discectomy(PEID)in the treatment of lumbar disc herniation,and analyze the causes and treatment strategies.Methods The clinical data of 122 patients with L_(5)-S_(1)segment disc herniation who underwent PEID from March 2018 to March 2020 in our department were retrospectively analyzed.There were 70 males and 52 females,aged 29-72 years old,with an average age of(42.9±11.3)years old.The course of disease was 7 to 23 months,with an average duration of(11.2±3.1)months.The patients were followed up for 1 year,and the preoperative and postoperative visual analogue scale(VAS)and the overall efficacy of 1 year after operation were evaluated.The postoperative complications were analyzed,and the causes and countermeasures were analyzed.Results All patients completed the PEID operation,compared with preoperation,the VAS score of patients after 1 year was significantly lower,the difference was statistically significant[1 year after operation(2.18±0.52)vs.preoperation(7.26±1.83);t=44.841,P<0.001].At 1 year after operation,the modified MacNab standard was used to evaluate the curative effect:excellent in 57 cases,good in 50 cases,fair in 8 cases,poor in 7 cases,the excellent and good rate was 87.7%.Postoperative complications occurred in 14 cases(11.48%),including 1 case of nerve root injury,3 cases of residual nucleus pulposus,1 case of retroperitoneal hematoma,2 cases of intervertebral space infection,6 cases of postoperative paresthesia and 1 case of cerebrospinal fluid leakage.All the above complications were recovered after symptomatic treatment or revision surgery.After 1 year follow-up,5 cases(4.1%)relapsed again,4 cases received microsurgery,1 case received lumbar fusion.Conclusion PEID is effective in the treatment of L_(5)-S_(1) segment disc herniation,which can significantly improve the symptoms of low back and leg pain.The early postoperative effect is stable,and the overall incidence of complications is not high.