椎间孔镜微创治疗极外侧型腰椎间盘突出症的体会.docx

椎间孔镜微创治疗极外侧型腰椎间盘突出症的体会

第一篇：椎间孔镜微创治疗极外侧型腰椎间盘突出症的体会椎间孔镜微创治疗极外侧型腰椎间盘突出症的体会【摘要】目的?u价椎间孔镜微创治疗极外侧型腰椎间盘突出症的可行性和有效性。方法对18例极外侧型腰椎间盘突出症患者进行经皮椎间孔镜治疗，通过视觉模拟评分法（VAS）评分和Oswestry功能障碍指数（ODI）评分进行疗效评价。结果18例患者均顺利完成手术，手术时间40～60min，平均手术时间（50.0±3.3）min；术中出血5～20ml，平均术中出血（10.0±3.3）ml；未出现术后感染、术中神经根损伤、硬膜囊撕裂、脑脊液漏等严重并发症。2例患者术后出现短期“日光烧灼现象”，经营养神经、脱水对症治疗1周内症状消失。所有患者术后均得到随访，随访时间3～15个月，平均随访（5.4±3.2）个月。手术前VAS评分为（8.3±0.3）分，术后3d为（2.5±0.2）分，术后3个月为（1.2±0.1）分；术后3d及术后3个月VAS评分低于手术前，差异均有统计学意义（t=68.2484、95.2565，P【关键词】经皮椎间孔镜；腰椎间盘突出症；极外侧型；微创DOI：10.14163/j.cnki.11-5547/r.2016.32.010【Abstract】ObjectiveToevaluatefeasibilityandeffectivenessbyminimallyinvasivepercutaneoustransforaminalendoscopeinthetreatmentofextremelylateralprotrusionoflumbarintervertebraldisc.MethodsAtotalof18patientswithextremelylateralprotrusionoflumbarintervertebraldiscreceivedpercutaneoustransforaminalendoscopefortreatment.Theircurativeeffectswereevaluatedbyvisualanaloguescale（VAS）scoreandOswestrydisabilityindex（ODI）score.ResultsAll18patientsreceivedsuccessfuloperation，withoperationtimeranged40～60minandmeanoperationtimeas（50.0±3.3）ml.Theyhadintraoperativebleedingvolumeranged5～20ml，withmeanintraoperativebleedingvolumeas（10.0±3.3）ml.Therewerenoseverecomplicationsofpostoperativeinfection，postoperativeneuralroottrauma，duralsacavulsion，andcerebrospinalfluidleakage.Therewere2caseswithshort-term“sunburning”，whichwererelievedaftersymptomatictreatmentfortrophicnerveanddehydrationfor1week.Allpatientsreceivedfollow-upfor3～15months，withmeanfollow-uptimeas（5.4±3.2）months.TheirVASscorewas（8.3±0.3）pointsbeforeoperation，（2.5±0.2）pointsinpostoperative3dand（1.2±0.1）pointsinpostoperative3months.TheirVASscoresin3dand3monthsafteroperationwerelowerthanthatbeforeoperation，andthedifferencehadstatisticalsignificance（t=68.2484，95.2565，P【Keywords】Percutaneoustransforaminalendoscope；Protrusionoflumbarintervertebraldisc；Extremelylateral；Minimallyinvasive极外侧型腰椎间盘突出症（farlaterallumbardischerniation，FLLDH）是腰椎间盘突出症中一种少见的类型，其临床症状表现为持续剧烈的下肢神经根性疼痛，保守治疗常不能缓解症状。本科从2013年11月起采用经皮椎间