[1]李毅力,王申,白玉,等.应用可视化椎弓根有限切除技术行经皮椎间孔入路内镜下椎间盘切除术治疗高度游离型腰椎间盘突出症[J].中医正骨,2023,35(03):68-72.
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应用可视化椎弓根有限切除技术行经皮椎间孔入路内镜下椎间盘切除术治疗高度游离型腰椎间盘突出症()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年03期
页码:
68-72
栏目:
临床报道
出版日期:
2023-03-20

文章信息/Info

作者:
李毅力1; 王申2; 白玉1; 代耀军1; 孙宜保1; 杨勇1
(1.郑州市骨科医院,河南 郑州 450052; 2.淅川县中医院,河南 淅川 474450)
关键词:
腰椎;  椎间盘移位;  椎间盘切除术;  内窥镜检查;  椎弓根有限切除
摘要:
目的:观察应用可视化椎弓根有限切除技术行经皮椎间孔入路内镜下椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗高度游离型腰椎间盘突出症(high-migrated lumbar disc herniation,HM-LDH)的临床疗效和安全性。方法:2018年1月至2019年1月,应用可视化椎弓根有限切除技术行PETD治疗HM-LDH患者68例。男39例,女29例。年龄24～59岁,中位数47岁。均为单节段椎间盘突出,其中L3～4 8例、L4～5 48例、L5S1 12例。突出的髓核组织向上游离41例,向下游离27例。记录手术时间、术中X线透视次数; 于术前和术后1个月、3个月、6个月、12个月及末次随访时,采用视觉模拟量表(visual analogue scale,VAS)评价腿部疼痛程度,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价腰部功能; 于术前和末次随访时采用简明健康状况调查表(short form 36 health survey questionnaire,SF-36)评估患者生活质量; 末次随访时,采用MacNab评定标准评价综合疗效; 随访观察并发症发生情况。结果:本组68例患者均顺利完成手术。手术时间(47.5±15.3)min。术中X线透视(3.13±1.56)次。所有患者均获随访,随访时间为29～41个月,中位数36个月。患者不同时间点腿部疼痛VAS评分和ODI均呈下降趋势[(6.06±1.20)分,(1.21±0.77)分,(1.01±0.59)分,(0.96±0.66)分,(0.93±0.65)分,(0.85±0.72)分,F=469.153,P=0.000;(54.65±12.55)%,(30.13±7.77)%,(23.63±6.28)%,(20.69±5.93)%,(19.24±5.53)%,(19.01±4.83)%,F=222.609,P=0.000]; 末次随访时,患者SF-36评分高于术前[(33.27±13.23)分,(66.81±12.35)分,t=-12.276,P=0.000],综合疗效优51例、良14例、可3例。2例患者术后第1天出现小腿后外侧麻木,均未发生神经根损伤、类脊髓高压综合征、感染、椎管内血肿等并发症。结论:应用可视化椎弓根有限切除技术行PETD治疗HM-LDH,手术时间短,术中X线透视次数少,能够缓解患者腿部疼痛、改善腰部功能、提高生活质量,且安全性高。

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备注/Memo

备注/Memo:
基金项目:河南省医学适宜技术推广项目(SYJS2020152)
通讯作者:杨勇 E-mail:13603862327@163.com
更新日期/Last Update: 1900-01-01