【摘要】 目的探讨经皮椎间孔镜治疗单侧腰椎间盘突出致对侧下肢出现症状体征患者的入路选择。方法回顾性分析2010年1月至2015年10月在本院采用经皮椎间孔镜治疗的对侧症状腰椎间盘突出患者80例,随机分为经症状侧入路组和经突出侧入路组,每组40例。记录两组术前及术后1天、术后7天的下腰部、臀腿部的视觉模拟评分(visual analogue scale,VAS),以及术前、术后3个月、术后6个月的Oswestry功能障碍指数(Oswestry disability index,ODI)评分,末次随访时采用改良Mac Nab标准评定疗效并进行组间比较。结果两组术前下腰部、臀腿部疼痛VAS评分及ODI评分比较差异无显著性(P>0.05),术后下腰部、臀腿部疼痛VAS评分及ODI评分均较术前明显改善,差异有显著性(P<0.05)。术后1天症状侧入路组患者臀腿部疼痛VAS评分明显低于突出侧入路组,差异有显著性(P<0.05);术后各时间点两组ODI评分比较差异无显著性(P>0.05)。末次随访时Mac Nab评分显示,突出侧入路组优良率为86.7%,症状侧入路组优良率为90%,组间比较差异无显著性(P>0.05)。结论经皮椎间孔镜治疗对侧症状腰椎间盘突出症时,采用症状侧入路可综合解除机械压迫、血运障碍、炎症刺激、免疫反应等致病因素,术后神经根性疼痛症状立即消失,效果优于经突出侧入路。更多还原

【Abstract】 Objective To investigate the selection of percutaneous endoscopic approach for the symptoms and signs of the contralateral lower extremities in unilateral lumbar disc herniation. Method Methods the clinical data of 80 patients with contralateral lumbar intervertebral disc protrusion were analyzed retrospectively. They were randomly divided into symptomatic lateral approach and prominent lateral approach in 40 cases. The VAS and ODI scores were evaluated before and after treatment, and the curative effect was evaluated by modified Mac Nab criteria at the last follow-up. Result The lower back pain, hip and leg pain, VAS score and ODI score were significantly improved in the two groups after operation, and the difference was statistically significant(P<0.05). Comparison between groups, The symptom side approach on the first postoperative day, was compared with the prominent lateral approach, the hip and leg pain, VAS score was statistically significant(P<0.05). At the last follow-up, Mac Nab score: The excellent rate of the disc herniation lateral approach group was 86.7%, and that of the symptomatic lateral approach group was 90%, the difference was not statistically significant. Conclusion The symptomatic lateral approach was aimed at comprehensive mechanical factors such as mechanical compression, disturbance of blood circulation, inflammatory stimuli and immune response. The symptoms of radicular pain disappeared immediately after operation, and the effect was better than that of the prominent lateral approach.更多还原