经皮脊柱内镜治疗腰椎间盘突出症的疗效观察.docVIP

经皮脊柱内镜治疗腰椎间盘突出症的疗效观察 　　【摘 要】目的：探?经皮脊柱内镜治疗腰椎间盘突出症的安全性及临床疗效。方法：2015年7月至2016年6月，我院应用脊柱内镜技术治疗并获得随访的78例腰椎间盘突出症患者的临床资料，比较本组患者手术前后的直腿抬高角度、手术时间、术中G型臂X线透视次数、住院时间、手术并发症、术前和术后1、3、6、12个月分别进行疼痛视觉模拟量表（visualanaloguescale，VAS）和Oswestry功能障碍指数（ODI）评分，并参照改良Macnab标准评估临床疗效及是否推荐本手术。并于术后第一天、术后6月复查MRI评估椎间盘摘除及修复情况。结果：78例患者均顺利完成手术，并获得13～30个月的随访，平均随访16.8±3.0个月。本组患者平均手术时间58±11.8min，平均出血量15±7ml，术中G型臂X线透视次数4.5±1.3次，住院时间3.7±1.3天。术中硬脊膜损伤2例，颈部疼痛3例，术后出现足下垂1例，短暂性臀中肌无力1例，下肢感觉异常8例。无复发及再手术病例。本组患者术后VAS评分、ODI评分均较术前明显改善，末次随访时改良Macnab标准评价优良率为86.5%。术后第一天核磁检查示椎间盘摘除及减压充分，术后6月核磁检查示椎间盘修复完整。获得患者93%的手术推荐。结论：脊柱内镜技术治疗腰椎间盘突出症具有创伤小，恢复快、并发症低、不破坏脊柱稳定性等优势，患者满意度高，疗效确切。 　　【关键词】微创；腰椎间盘突出症；脊柱内镜；椎间孔入路；椎板间入路 　　Treatment of lumbar intervertebral disc herniation by percutaneous spinal endoscopy. 　　Zhang xiaoming zhao xingyu meng xin du tao liu changchun pu zhikun Chen.（Tongjiang county peoples hospital orthopedic sichuan ba zhong 636700.） 　　Abstract Objective： To explore the safety and clinical efficacy of percutaneous endoscopic treatment of lumbar intervertebral disc herniation. Methods： July 2015 to June 2016，our application of endoscopic technique treatment and follow-up of the spine，the clinical data of 78 cases of patients with lumbar disc prolapse，compare the patients before and after surgery the straight leg-raising Angle type，operation time， intraoperative G arm X-ray fluoroscopy times， length of hospital stay，complications，preoperative and postoperative 1，3，6and 12 months respectively pain visual analog scale （visual analogue scale，VAS） and Oswestry disability index （ODI） score，and reference to the modified Macnab criteria to evaluate the clinical curative effect and whether recommend this surgery.The MRI evaluation was performed on the first day after the surgery，and the MRI evaluation was performed in June. Results： all the 78 patients completed the operation successfully and were followed up for 13～30 months，with an average follow-up of 16.8 + + 3 months.The average operation time of the patients in this grou