经皮内窥镜下腰椎椎间盘切除术治疗双节段腰椎椎间盘突出症

目的探讨经皮内窥镜下腰椎椎间盘切除术(PELD)治疗双节段腰椎椎间盘突出症的安全性和有效性。方法回顾性分析2012年5月—2014年1月本院收治的33例双节段腰椎椎间盘突出症患者资料,均为L4/L5/S1椎间盘突出,男27例,女6例;年龄17~52岁,平均34.5岁;椎间盘突出在同侧14例,不同侧19例。局麻后在C形臂X线机透视监护下分节段行靶向穿刺,应用PELD行椎间盘髓核摘除。采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)和Mac Nab标准评估手术疗效。结果所有病例手术均顺利完成,手术时间50~110 min,平均75 min;出血量25~55 m L,平均25 m L;所有患者随访12~22个月,平均18.5个月。术后1周、3个月、6个月、12个月的VAS评分均较术前明显下降,差异具有统计学意义(P0.05)。术后12个月,ODI由术前平均48.8%降至平均9.7%,差异具有统计学意义(P0.05),按Mac Nab标准评定疗效优良率为96.9%(31/33)。结论 PELD治疗双节段腰椎椎间盘突出症具有创伤小、并发症少、对脊柱稳定性影响小、术后恢复快等优点,近期疗效可靠。

Percutaneous endoscopic lumbar discectomy for treatment of double segment lumbar disc herniation

Objective To explore the safety and the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for the treatment of double-segment lumbar disc herniation. Methods From May 2012 to January 2014, data of 33 patients with double-segment lumbar disc herniation were analyzed retrospectively. The patients were composed of 27 males and 6 females, aged 17-52 years old, with a mean of 34.5 years. Their target segments were L₄/L₅/S₁. The herniated intervertebral disc was located on the same side in 14 cases, and on the different side in 19. After local anesthesia, the target lumbar disc was positioned under the C-arm fluoroscope with PELD. Visual analogue scale (VAS) score, Oswestry disability index (ODI) and MacNab criteria were used to evaluate the clinical effects. Results The operation was successful in all the cases. The mean operation time was 75 min, ranged 50-110 min. The mean blood loss was 25 mL, ranged 25-55 mL. All the patients were followed up for 12-22 months, mean 18.5 months. The VAS scores at 1 week, 3 months, 6 months and 1 year post-operation were significantly lower than those at pre-operation, and the difference was statistically significan(P<0.05). The ODI decreased from mean 48.8% pre-operation to mean 9.7% post-operation, and the difference was statistically significan(P<0.05). The efficacy rate of 96.9% through MacNab criteria. Conclusion The treatment of double-segment lumbar disc herniation with PELD has the advantages of less trauma, fewer complications, small influence on the stability of the spine, rapid postoperative recovery and a reliable short-term effect.