经皮内镜椎板间入路治疗钙化型腰椎间盘突出症早期临床疗效分析

目的：探讨经皮内镜椎板间入路技术治疗钙化型腰椎间盘突出症的临床疗效及手术技巧。方法2011年11月至2013年6月，我院收治的钙化型腰椎间盘突出症患者共56例，分别采用经皮内镜椎板间入路手术（I组，28例）和传统开窗手术（II组，28例）治疗。于术前及术后1天、3个月、6个月，采用Oswestry功能障碍指数（oswestrydisabilityindex，ODI）、视觉疼痛模拟评分（visualanaloguescale，VAS）和MacNab改良的疗效评定标准对患者进行评估，并统计手术时间、术中出血量、切除骨量、术后并发症、住院时间等指标。结果两组手术疗效明显，术后1天、3个月、6个月两组VAS评分分别为（3.52±0.23，2.99±0.11，3.15±0.19；4.02±0.23，3.48±0.13，3.03±0.04），较术前（7.36±0.29；7.29±0.28）均有明显改善；ODI指数分别从术前（70.18±1.63；69.82±1.31）降至（34.24±1.39，32.84±1.38，33.33±1.40；36.51±1.39，33.50±1.50，32.48±2.87），术后6个月两组VAS评分和ODI指数差异均无统计学意义（P＝0.34，P＝0.80）。术后6个月，依据MacNab标准，两组患者优良率差异无统计学意义（96.4%∶92.9%，P＝0.62）。I组在术中出血量、切除骨量、住院时间均明显优于II组（P＜0.001）；手术时间I组长于II组（52.93±6.66分：41.79±7.85分，P＜0.001）。术后并发症，I组2例下肢麻木，1例硬膜破裂；II组1例下肢麻木，4例经保守对症治疗后均痊愈，无永久性神经损害或症状加重。结论与传统开窗手术相比，经皮内镜椎板间入路技术治疗钙化型腰椎间盘突出症可以达到相同的临床疗效，同时具有组织损伤小、手术时间及住院康复时间短等优势。

An analysis of short-term clinical outcomes of percutaneous endoscopic interlaminar approach for calcified lumbar disc herniation

Objective To investigate the clinical outcomes and surgical techniques of percutaneous endoscopic interlaminar approach for calciifed lumbar disc herniation. Methods From November 2011 to June 2013, 56 patients with calciifed lumber disc herniation were adopted, who were then divided into 2 groups. The patients in Group I （ n=28 ） were treated with percutaneous endoscopic interlaminar approach, and the patients in Group II （ n=28 ） underwent traditional open surgery. The assessment was performed using the Oswestry Disability Index （ ODI ）, Visual Analogue Scale （ VAS ） and the modiifed Macnab criteria preoperatively and at 1 day, 3 months and 6 months after the operation. The parameters were recorded such as the operation time, intraoperative blood loss, amount of removed bone, postoperative complications, hospital stays and so on. Results The surgical results in both groups were satisfactory. The preoperative VAS scores were 7.36±0.29 points in Group I, which were signiifcantly improved to 3.52±0.23, 2.99±0.11 and 3.15±0.19 points at 1 day, 3 months and 6 months after the surgery. The preoperative VAS scores were 7.29±0.28 points in Group II, which were signiifcantly improved to 4.02±0.23, 3.48±0.13 and 3.03±0.04 points at 1 day, 3 months and 6 months after the surgery. The preoperative ODI scores were 70.18±1.63 points in Group I, which were decreased to 34.24±1.39, 32.84±1.38 and 33.33±1.40 points at 1 day, 3 months and 6 months after the surgery. The preoperative ODI scores were 69.82±1.31 points in Group II, which were decreased to 36.51±1.39, 33.50±1.50 and 32.48±2.87 points at 1 day, 3 months and 6 months after the surgery. No obvious differences in the VAS score and ODI score at 6 months after the surgery were noticed between the 2 groups （ P=0.34, P=0.80 ）. According to the MacNab criteria, the excellent and good rates were 96.4%and 92.9%, without statistically signiifcant differences between the 2 groups （ P=0.62 ）. When it came to the intraoperative blood loss, a