动力辅助下经皮全内窥镜结合全可视椎间孔成形术治疗腰椎间盘突出症疗效观察
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摘要
目的如何提高椎间孔成形技术治疗的操作安全性已成为临床研究热点。文中旨在观察动力辅助下经皮全内窥镜结合全可视椎间孔成形术治疗腰椎间盘突出症的临床效果。方法收集2017年1月至11月江苏省中西医结合医院骨伤科61例腰椎间盘突出症患者。对患者进行动力辅助下经皮全内窥镜结合全可视椎间孔成形技术治疗。采用疼痛视觉模拟评分量表(VAS)、功能障碍指数(ODI)和改良Macnab疗效评定标准进行临床疗效评定。结果术后3 d、术后3个月、术后6个月VAS评分[(1.10±0.60)、(1.03±0.26)、(1.07±0.31)分]较术前[(7.64±1.11)分]明显降低(P<0.05); ODI评分[(2.10±0.54)、(1.30±0.49)、(1.23±0.46)分]较术前[(34.46±3.57)分]亦明显降低(P<0.05)。患者优良率96.72%(59/61)。所有患者术后无神经根损伤、脊髓损伤、硬脊膜破裂等并发症,无复发患者。结论动力辅助下经皮全内窥镜下结合全可视椎间孔成形技术治疗腰椎间盘突出症安全有效。
Objective How to improve the operational safety of foraminoplasty has become a hot spot in present clinical research. This study was to observe the clinical effect of minimally invasive treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy( PTED) combined with dynamically assisted visualized intervertebral foraminoplasty( VIVF). Methods Totally,61 patients with lumbar disc herniation underwent PTED combined with dynamically assisted VIVF in Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January to November 2017. We evaluated the clinical effects using the Visual Analogue Scale( VAS),Oswestry Disability Index( ODI) and modified Macnab Criteria. Results The VAS scores of the patients were significantly lower at 3 days,3 months and 6 months after surgery than the baseline( 1.10±0.60,1.03±0.26 and 1.07±0.31 vs 7.64± 1.11,P< 0.05),and so were the ODIs( 2.10± 0.54,1.30±0.49 and 1.23±0.46 vs 34.46±3.57,P< 0.05). The excellence rate of treatment 96.72%( 59/61). None of the patients experienced such postoperative complications as nerve root injury,spinal injury,and dural matter,and no recurrence was observed. Conclusion PTED combined with dynamically assisted VIVF is safe and effective for the treatment of lumbar disc herniation.
Objective How to improve the operational safety of foraminoplasty has become a hot spot in present clinical research. This study was to observe the clinical effect of minimally invasive treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy( PTED) combined with dynamically assisted visualized intervertebral foraminoplasty( VIVF). Methods Totally,61 patients with lumbar disc herniation underwent PTED combined with dynamically assisted VIVF in Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January to November 2017. We evaluated the clinical effects using the Visual Analogue Scale( VAS),Oswestry Disability Index( ODI) and modified Macnab Criteria. Results The VAS scores of the patients were significantly lower at 3 days,3 months and 6 months after surgery than the baseline( 1.10±0.60,1.03±0.26 and 1.07±0.31 vs 7.64± 1.11,P< 0.05),and so were the ODIs( 2.10± 0.54,1.30±0.49 and 1.23±0.46 vs 34.46±3.57,P< 0.05). The excellence rate of treatment 96.72%( 59/61). None of the patients experienced such postoperative complications as nerve root injury,spinal injury,and dural matter,and no recurrence was observed. Conclusion PTED combined with dynamically assisted VIVF is safe and effective for the treatment of lumbar disc herniation.
引文
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[11]赵宏,李纯志,方煜,等.椎间孔镜max More技术治疗青少年腰椎间盘突出症[J].中国微创外科杂志,2017,17(5):432-436.
[12]邓斌,吴继彬,孙玛骥,等.椎间孔镜可视下动力磨钻系统在椎间孔成形术中的作用[J].徐州医学院学报,2017,37(12):846-848.
[13]Ahn Y,Oh HK,Kim H,et al.Percutaneous endoscopic lumbar foraminotomy:an advanced surgical technique and clinical outcomes[J].Neurosurgery,2014,75(2):124-133.
[14]Kim HJ,Jeong JH,Cho HG,et al.Comparative observational study of surgical outcomes of lumbar foraminal stenosis using minimally invasive microsurgical extraforaminal decompression alone versus posterior lumbar interbody fusion:a prospective cohort study[J].Eur Spine J,2015,24(2):388-395.
[2]顾红林,张烽,周敦,等.改良椎间孔成形术在经椎间孔脊柱内镜中的应用[J].江苏医药,2017,43(7):511-513.
[3]蓝彬,柳达,周广平,等.腰椎间孔成形技术在脊柱内镜手术应用中的研究进展[J].实用骨科杂志,2018,24(5):434-437.
[4]徐海栋,付强,赵建宁.Quadrant微创系统下Coflex非融合固定治疗腰椎间盘突出症的疗效观察[J].医学研究生学报,2013,26(11):1172-1174.
[5]闫韵飞,赵建宁,许斌.腰椎间盘切除术椎前血管损伤并发症的文献分析[J].医学研究生学报,2013,26(6):610-614.
[6]周跃,李长,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
[7]Yeung AT,Tsou PM.Posterolateral endoscopic excision for lumbar disc herniation:Surgical technique,outcome,and complications in 307 consecutive cases[J].Spine(Phila Pa 1976),2002,27(7):722-731.
[8]Hoogland T,Schubert M,Miklitz B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain:a prospective randomized study in280 consecutive cases[J].Spine(Phila Pa 1976),2006,31(24):890-897.
[9]Liao Z,Chen W,Wang CH.Transforaminal percutaneous endoscopic surgery for far lateral lumbar intervertebral disk herniation[J].Orthopedics,2014,37(8):e717-727.
[10]李振宙,吴闻文,侯树勋,等.经皮侧后路腰椎间孔成形术手术器械的设计与临床应用[J].中华骨科杂志,2011,31(10):1026-1032.
[11]赵宏,李纯志,方煜,等.椎间孔镜max More技术治疗青少年腰椎间盘突出症[J].中国微创外科杂志,2017,17(5):432-436.
[12]邓斌,吴继彬,孙玛骥,等.椎间孔镜可视下动力磨钻系统在椎间孔成形术中的作用[J].徐州医学院学报,2017,37(12):846-848.
[13]Ahn Y,Oh HK,Kim H,et al.Percutaneous endoscopic lumbar foraminotomy:an advanced surgical technique and clinical outcomes[J].Neurosurgery,2014,75(2):124-133.
[14]Kim HJ,Jeong JH,Cho HG,et al.Comparative observational study of surgical outcomes of lumbar foraminal stenosis using minimally invasive microsurgical extraforaminal decompression alone versus posterior lumbar interbody fusion:a prospective cohort study[J].Eur Spine J,2015,24(2):388-395.