PELD治疗腰椎间盘突出症的疗效观察

【摘要】 目的 观察脊柱内镜下椎间盘摘除术(PELD)治疗腰椎间盘突出症临床疗效。方法 回顾2015年11月至2018年1月行经皮椎间孔镜治疗腰椎间盘突出症的患者共37例。所有患者术前按Pfirrmann腰椎间盘退变分级为Ⅱ～Ⅲ级。分析比较术前及术后的VAS评分;采用Oswestry功能障碍指数问卷表(ODI)得出ODI评分;比较下肢神经感觉恢复情况。通过术后改良MacNab评分评估术后情况,分为优、良、一般、差,计算满意度=(优+良)/患者总数×100%。结果 所有患者均顺利实施了PELD手术,住院时间平均3～5d,手术时间30～45min。所有患者的术中及术后出血量均较少。术前及术后各时间点VAS、ODI指数比较,差异有统计学意义(P<0.05);下肢神经感觉及腱反射情况总体恢复良好。术后末次随访MacNab评分标准示:优30例、良4例、一般1例、差2例,优良率91.9%。末次随访未发现原手术部位椎间盘再突出、邻近节段退变加重及脊柱不稳等情况。结论 PELD治疗腰椎间盘突出症近期疗效确切。至于其安全、并发症方面仍需大量实践检验。更多还原

【Abstract】 Objective To observe the clinical efficacy of endoscopic lumbar discectomy(PELD) in the treatment of lumbar disc herniation.Methods From November 2015 to January 2018, 37 patients with lumbar disc herniation were treated by percutaneous transforaminal endoscopy.All patients were graded according to Pfirrmann lumbar disc degeneration grade Ⅱ-Ⅲ.The VAS scores before and after operation were analyzed and compared, and the ODI scores were obtained by Oswestry Dysfunction Index Questionnaire(ODI),and the neurosensory recovery of lower extremity was compared.The postoperative condition was assessed by modified MacNab score, which was classified as excellent, good and general,and poor.Satisfaction=(excellent+good)/total number of patients was calculated×100%. Results All patients underwent PELD operation successfully.The average length of stay was 3～5 d.The operation time was 30～45 min.All patients had less intraoperative and postoperative bleeding. The VAS and ODI indexes were significantly different before and after operation(P<0.05), and the nerve sensation and tendon reflex of lower extremity recovered well. At the end of follow-up, the MacNab score showed excellent in 30 cases, good in 4, fair in 1 cases, and poor in 2 cases.The excellent and good rate was90. At the last follow-up, no disc herniation, degeneration of adjacent segments and spinal instability were found. Conclusion PELD is effective in the treatment of lumbar disc herniation. As for its safety and complications, a large number of practical tests are still needed.更多还原