侧后路椎间孔镜下髓核摘除术治疗腰椎间盘突出症

目的 探讨侧后路椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床疗效。方法 将80例腰椎间盘突出症患者根据手术方法不同分为孔镜组(采用侧后路椎间孔镜下髓核摘除术治疗，42例)和开窗组(采用后正中入路椎板间开窗髓核摘除术治疗，38例)。比较两组手术时间、切口长度、术中出血量及JOA评分。结果 患者均获得随访，时间3～14个月。两组手术时间比较差异无统计学意义(P>0.05)。切口长度、术中出血量孔镜组均短(少)于开窗组(P<0.001)。术后3个月JOA评分两组均较术前明显改善(P<0.05),两组间比较差异无统计学意义(P>0.05)。结论 侧后路椎间孔镜下髓核摘除术治疗腰椎间盘突出症具有切口小、出血少等优点，且能达到同开放手术相同的直接减压效果。     

侧后路椎间孔镜与后路椎间孔镜治疗腰椎间盘突出症的临床疗效观察

目的探讨侧后路椎间孔镜(PTED)与后路椎间孔镜(PEID)治疗腰椎间盘突出症(LDH)的效果。方法选择2017-08—2018-08间陆军第83集团军医院收治的66例LDH患者,按照不同手术方法分为PTED组和PEID组,各33例。回顾性分析患者的临床资料。结果 (1)PEID组手术时间、透视次数显著少于PTED组,术中出血量、住院时间显著多于PTED组。差异均有统计学意义(P0.05)。(2)PTED组总有效率高于PEID组,差异有统计学意义(P0.05)。(3)手术前后2组患者组间VAS、ODI评分均差异无统计学意义(P0.05);组内比较,VAS、ODI评分均较术前显著改善,差异有统计学意义(P0.05)。结论 PTED与PEID手术均为微创、有效、安全的LDH治疗方法。PTED术中出血量更少,更符合微创手术理念,有助于缩短患者康复时间。可根据患者具体情况合理选择。     

经皮椎间孔镜下髓核摘除术治疗中央型腰椎间盘突出症

正腰椎间盘突出症(lumbar disc herniation,LDH)是造成成年人腰腿疼痛最常见的原因之一,经皮椎间孔镜下髓核摘除术在LDH手术治疗中具有微创、恢复快、并发症少等优势[1]。但目前对经皮椎间孔镜下髓核摘除治疗LDH的报道较为笼统,少见经皮椎间孔镜技术治疗中央型LDH的报道。本研究主要观察经皮椎间孔镜下髓核摘除手术治疗中央型LDH的疗效及安全性,报     

侧后路经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症临床效果观察

目的 观察侧后路经皮椎间孔镜髓核摘除术(PTED)治疗腰椎间盘突出症(LDH)的应用效果。方法 回顾性分析2019-04—2021-09孟津县人民医院骨科收治的84例LDH患者的临床资料,根据手术方案分为侧后路PTED组(PTED组)和后路椎板间开窗髓核摘除术组(对照组),各42例。比较2组患者的基线资料。记录患者的手术时间、术中出血量、术后住院时间、并发症发生率。手术前及术后3个月采用腰椎日本骨科协会(JOA)评分标准评价腰椎功能。手术前和术后第1天、第3天、第7天、1个月时,采用视觉模拟评分法(VAS)评分评价患者的疼痛程度。结果 2组患者的基线资料差异无统计学意义(P>0.05)。PTED组患者的手术时间长于对照组,术中出血量少于对照组,术后住院时间短于对照组,并发症发生率低于对照组。术后3个月的JOA评分高于对照组,术后第1天和第3天的VAS评分低于对照组。以上差异均有统计学意义(P<0.05)。结论 侧后路经皮PTED治疗LDH,虽然手术时间较长,但手术创伤轻、并发症少、患者腰椎功能恢复和疼痛改善程度更理想。     

经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症临床分析

目的分析经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症的临床价值。方法对48例腰椎间盘突出症患者实施经皮椎间孔镜髓核摘除术。应用改良Macnab标准、Oswestry功能障碍(ODI)指数及疼痛视觉模拟(VAS)评分评价疗效。结果术后均随访6个月,优良率为93.75%(45/48)。未发生脊髓神经损伤等并发症。术后3个月及6个月时患者的ODI指数及VAS评分均显著优于术前,差异有统计学意义(P0.05)。结论经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症,创伤小、并发症少,可明显改善术后生活质量,效果满意。     

椎间孔镜靶向技术治疗中青年腰椎间盘突出症

[目的]探讨靶向穿刺经皮椎间孔镜下腰椎间盘切除术治疗腰椎间盘突出症的安全性和有效性。[方法]2014年4月～2016年12月,采用靶向穿刺椎间孔镜治疗单节段青年腰椎间盘突出症患者131例,其中男90例,女41例,年龄18～44岁,平均(33.50±7.55)岁。采用VAS评分、ODI评分、JOA评分和改良MacNab标准评估手术疗效,MRI测量椎间隙高度变化。[结果]本组131例患者,均顺利完成手术,未发生血管、内脏损伤等并发症,虽发生4例硬膜损伤,但无不良后果。手术时间平均(112.84±26.26) min,术中出血量平均(31.87±26.33) ml。随访12～28个月,平均(17.41±6.20)个月。腿痛VAS评分由术前(5.89±1.06)减少至术后12个月(1.02±0.75)分;腰痛VAS评分由术前(3.17±1.51)减少至术后12个月(0.99±0.90)分;ODI评分由术前(55.15±10.86)减少至术后12个月(10.76±6.78)分,而JOA评分由术前(8.91±4.10)分增加至术后12个月(26.29±2.29)分,上述指标变化差异均有统计学意义(P0.05)。按照MacNab评价标准,术后1个月优良率98.47%,术后6个月优良率94.66%,术后12个月优良率91.60%。本组131例中,原间隙复发5例,复发率为3.82%。[结论]经皮椎间孔镜靶向技术治疗腰椎间盘突出症创伤小、并发症少、术后恢复快、近期疗效可靠,靶向穿刺是手术成功的首要前提和重要步骤。     

经皮椎间孔镜技术治疗腰椎间盘突出症的疗效分析

目的探讨经皮椎间孔镜技术(TESSYS)治疗腰椎间盘突出症的临床疗效。方法回顾性分析自2012-07—2014-03采用TESSYS技术治疗的腰椎间盘突出症128例。比较手术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),末次随访时采用改良Macnab标准评定手术疗效。结果本组手术时间65~160 min,平均95 min;其中建立通道时间35~70 min,平均50 min;镜下操作时间30~65 min,平均45 min。本组随访时间3~24个月,平均18.5个月。术后无复发患者。术后1例(L3神经根损伤)出现股四头肌无力,术后6周完全恢复。术后3个月(t=39.574,P0.001)、6个月(t=53.358,P0.001)VAS评分较术前明显降低,差异有统计学意义(P0.05)。术后3个月(t=40.998,P0.001)、6个月(t=54.578,P0.001)ODI指数较术前明显降低,差异有统计学意义(P0.05)。末次随访时采用改良Macnab标准评定临床效果:优109例,良11例,可8例,优良率93.8%。结论 TESSYS技术是治疗腰椎间盘突出症安全有效的新技术,具有微创、安全、适应证广、疗效可靠、恢复快的优点。     

经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症的疗效观察

目的 观察经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症的临床疗效.方法 175例腰椎间盘突出症患者随机分为两组,观察组80例采用椎间孔镜TESSYS技术治疗,对照组95例采用小切口腰椎间盘髓核摘除术治疗,两组随访时间为6～ 13个月,平均8个月,比较两组疗效.结果 根据Macnab疗效评定标准,观察组优良率(76.3％)明显高于对照组(61.1％)(P＜0.05);观察组术中出血量少于对照组,手术切口长度短于对照组(P＜0.05);两组患者术后VAS和ODI评分较术前明显改善(P＜0.05),观察组改善更为显著(P＜0.05).结论 经皮椎间孔镜TESSYS技术是治疗腰椎间盘突出症的有效方法,具有手术切口小,术中出血量少,术后腰痛程度轻,腰部功能恢复好等优点,值得临床推广应用.     

椎间孔镜靶向单通道髓核摘除术治疗重度脱出移位型青年腰椎间盘突出症效果观察

目的观察椎间孔镜靶向单通道髓核摘除术(TO-PETD)治疗重度脱出移位型青年腰椎间盘突出症(HMLDH)的效果。方法选取2015-11-2018-06间收治的68例青年HMLDH患者,依据不同手术方案分为2组,各34例。对照组实施椎板开窗单纯髓核摘除术(FD),观察组实施TO-PETD术。回顾性分析患者的临床资料。结果观察组术中出血量少于对照组,术后24 h VAS评分低于对照组,总住院时间短于对照组,术后1、6、12个月的JOA评分高于对照组。差异均有统计学意义(P<0.05)。结论 TO-PETD术治疗青年HMLDH患者,能显著减少术中出血量,缓解术后疼痛感,有利于腰椎功能的恢复。     

椎间孔镜技术治疗腰椎间盘突出症

目的分析椎间孔镜（transforaminal endoscopic spine system,TESSYS）技术治疗腰椎间盘突出症的临床疗效,重点探讨治疗复杂类型腰椎间盘突出症的可行性。方法自2011年4月至2012年11月采用脊柱TESSYS技术治疗腰椎间盘突出症患者102例,共132个椎间盘。所有手术均采用德国标准椎间孔镜侧后方经皮穿刺路径方案,采用视觉模拟疼痛评分和改良Macnad标准评定手术疗效。结果腰痛及下肢放射痛的视觉模拟评分术前为（8.7±1.2）分,术后3d为（3.5±1.4）分,末次随访（1.5±1.1）分;术前、术后经统计学处理差异有统计学意义（P〈0.01）。改良Macnad标准临床效果评定结果为优52例,良40例,可6例,差4例,优良率为90.2%。患者对疼痛缓解满意率为95.2%。结论 TESSYS是治疗腰椎间盘突出症较为安全有效的新技术,具有创伤小、出血少、视野清晰、操作精准、术后恢复快、安全性能好、手术效果优良等优点。     

经皮椎间孔镜治疗不同年龄段腰椎间盘突出症的短期疗效对比

目的 分析比较经皮椎间孔镜间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)治疗不同年龄段腰椎间盘突出症(lumbar disc herniation,LDH)的短期疗效.方法 2018年1月至8月,前瞻性纳入需行PELD治疗的107例LDH病人,以年龄为依据分组...     

快速康复内窥镜椎间盘切除术治疗腰椎间盘突出症的临床观察

目的:探讨快速康复外科理念联合内窥镜椎间盘切除术治疗腰椎间盘突出症的疗效。方法:选取2018年4月—2019年4月本院收治的86例腰椎间盘突出症患者,随机分为两组,每组43例,对照组通过内窥镜椎间盘切除术治疗,观察组予以快速康复外科理念联合内窥镜椎间盘切除术治疗,对比两组疗效和并发症发生情况。结果:观察组并发症发生率(4.65%)较对照组(18.60%)低,差异有统计学意义(P 0.05);观察组下床活动时间、住院时间较对照组短,术后7天的疼痛评分较对照组低,差异有统计学意义(P 0.05);术后3个月,观察组的Oswestry功能障碍指数问卷表评分较对照组低,日本骨科协会评估治疗分数较对照组高,差异有统计学意义(P 0.05)。结论:探讨快速康复外科理念联合内窥镜椎间盘切除术治疗腰椎间盘突出症可减少并发症,缩短术后恢复时间,进而促进患者功能有效康复。     

Percutaneous Endoscopic Lumbar Discectomy Using a Double‐Cannula Guide Tube for Large Lumbar Disc Herniation

ObjectiveTo compare the effect of percutaneous endoscopic lumbar discectomy (PELD) using a double‐cannula guide tube (DGT), traditional PELD, and open lumbar discectomy (OLD) to treat large lumbar disc herniations (LLDHs).MethodsSeventy patients who presented with LLDH without cauda equina syndrome and were treated with surgery in our hospital from October 2015 to October 2017 were included. The detailed index included the visual analog scale (VAS) for back and radicular leg pain and the Oswestry Disability Index (ODI) in the immediate preoperative period and at the final follow‐up. The operation time, radiation exposure time, surgical satisfaction rate, and modified MacNab criteria score were also recorded.ResultsThe leg and back pain of the patients in these groups improved significantly in the postoperative period. No significant differences were observed in leg pain improvement between the other two groups; however, patients in the PELD group (with or without DGT) presented with significantly higher improvement in back pain than the OLD group (t = 9.965, p < 0.001). The final ODI scores were 12.1 ± 4.9, 11.2 ± 2.9, and 16.4 ± 3.6 in the PELD, PELD‐DGT, and OLD groups, respectively. Patients in the PELD and PELD‐DGT groups presented with significantly lower postoperative ODI scores than those in the OLD group (t = 20.834, p < 0.001). The mean postoperative hospital stays were significantly shorter in the PELD group and PELD with DGT group than in the OLD group (t = 46.688, p < 0.001). The mean operation time was significantly shorter in the PELD‐DGT group than those in the PELD group (t = 25.281, p = 0.001). No perioperative complications were observed in either group. Based on the modified MacNab criteria, excellent and good outcomes were achieved in 20 out of 21 patients (95.2%) in the PELD group, 23 out of 24 patients (95.8%) in the PELD‐DGT group, and 22 out of 25 patients (88.0%) in the OLD group. The rates of excellent and good outcomes were higher in the PELD and PELD‐DGT groups than in the OLD group, but there were no significant differences (χ ² = 1.454, p = 0.835).ConclusionsPELD using DGT is a safe and effective option for LLDH and features advantages such as improvements in back pain, a lower hospitalization cost than OLD, a shorter operation time, and less fluoroscopy than traditional PELD.     

腰椎间盘间孔突出症

腰椎间盘间孔突出症在腰椎间盘突出症中并非少见，诊断主要依据以下四点：（１）腿部症状严重；（２）典型神经障碍；（３）椎间手术后证实；（４）ＣＴ检查。本文详细讨论了该病的论断的技巧和效果。     

经皮内窥镜腰椎间盘切除术与开放腰椎间盘摘除术治疗的临床对比研究

目的比较经皮内窥镜腰椎间盘切除术(PELD)和开放腰椎间盘摘除术(OLD)的临床疗效。方法对100例腰椎间盘突出症根据手术方法不同,分为PELD组和OLD组。手术效果按照Oswestry功能障碍指数(ODI)、疼痛视觉类比评分(VAS)和改良的MacNab标准评定。结果PELD组平均随访24.3个月,单个节段平均手术时间60min,失血11ml,术后卧床24h。OLD组平均随访24.5个月,单个节段平均手术时间50min,失血30ml,术后卧床120h。两组采用改良MacNab标准评定随访结果,PELD组优良率为92%,OLD组96%。PELD组和OLD组术后ODI、VAS与术前比较,明显改善(P<0.05)。结论在严格选择手术适应证的情况下,PELD和OLD具有相似的近期临床疗效,但是PELD具有切口小、创伤小和术后恢复较快等优点。     

复元活血汤加减联合椎间孔镜治疗腰椎间盘突出症的临床疗效研究

目的:观察复元活血汤加减联合椎间孔镜治疗腰椎间盘突出症的临床疗效。方法:选取我院2017年6月—2020年12月收治的腰椎间盘突出症患者80例,按照随机数字表分为治疗组与对照组,每组40例。治疗组采用复元活血汤加减联合椎间孔镜手术治疗,对照组仅采用椎间孔镜手术治疗。记录并比较两组患者治疗前、术后1 d,术后2周、1个月、3个月的疼痛视觉模拟评分(VAS评分)、Oswestry功能指数(ODI评分)、JOA评分、足底红外热成像温差值。结果:术前、术后1 d、术后2周,两组患者腰腿疼痛VAS评分差异无统计学意义(P>0.05);术后1个月、术后3个月,治疗组腰腿疼痛VAS评分低于对照组,差异有统计学意义(P<0.05);患者术前、术后1 d,两组ODI评分差异无统计学意义(P>0.05);术后2周、术后1个月、3个月,治疗组ODI评分低于对照组,差异有统计学意义(P<0.00);术前、术后1 d,两组患者JOA评分差异无统计学意义(P>0.05);术后2周、术后1个月、3个月JOA评分,治疗组低于对照组,差异有统计学意义(P<0.05);术前、术后1 d、术后2周,两组患者足底红外温差差异无统计学意义(P>0.05);术后1个月、3个月,两组足底红外温差有统计学意义(P<0.05)。结论:复元活血汤加减联合椎间孔镜治疗腰椎间盘突出症的临床效果较好,术后肢体疼痛、功能恢复快,且并发症少。     

Evaluation of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Disc Herniation: A Retrospective Study

ObjectiveThe objective of the present study was to evaluate the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and open fenestration discectomy (OFD) in the treatment of lumbar disc herniation (LDH).MethodsPatients in our hospital with LDH who received PTED (n = 71) and OFD (n = 39) from 2013 to 2014 were retrospectively studied. Patient information, including age, gender, visual analogue scale (VAS) score for low back pain and leg pain, body weight, height, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and recurrence, was collected. The patients in the two groups were followed up for an average of 63 months after surgery.ResultsA total of 136 patients completed the operation and 110 patients were followed up completely. There was no significant difference in baseline data between the two groups (P > 0.05). The postoperative low back pain, leg pain, ODI, and JOA of the two groups were better than those preoperatively (P < 0.05). One week after surgery, the recovery of PTED patients was better than that of OFD. The ODI score of the PTED group was lower than that of the OFD group (10 [8, 12] vs 14 [11, 16]; P < 0.05), the waist VAS score of the PTED group was lower than that of the OFD group (2 [2, 3] vs 3 [2, 4]; P < 0.05), the leg VAS score of the PTED group was lower than that of the OFD group (1 [0,1] vs 1 [1, 2]; P < 0.05), while the JOA score of the PTED group was higher than that of OFD group [19(16, 20) vs 12(10, 17); P < 0.05]. There were no significant differences in ODI, JOA, waist and leg VAS scores between the two groups at 1 month after surgery and at subsequent follow‐up (P > 0.05). At the end of the follow up, 89.7% (35/39) of patients in the OFD group had excellent improvement in the JOA score, and 88.7% (63/71) of patients in the PTED group had an excellent improvement. There was no significant difference between the two (P > 0.05). There was also no significant difference in the recurrence rate between the two groups [(5/71) vs (3/39); P > 0.05]. [Correction added on 05 March 2021, after first online publication: “3/29” was amended to “3/39” in the preceding sentence.]ConclusionBoth PTED and OFD can achieve good mid‐term efficacy in the treatment of LDH but PTED has certain advantages, including the small incision, a shorter hospital stay, and quicker, earlier recovery. However, prospective randomized controlled studies with a larger sample size are needed.     

Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microscope‐Assisted Tubular Discectomy for Lumbar Disc Herniation

ObjectiveThe aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and microscope‐assisted tubular discectomy (MTD) for lumbar disc herniation (LDH).MethodsThis study had a retrospective design. From June 2017 to June 2018, the clinical data of 120 patients with LDH treated with PTED (60 cases, PTED group) and MTD (60 cases, MTD group) were analyzed and followed up for at least 20 months. There were 59 men and 61 women. Patients were aged between 22 and 80 years. The operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy, cost, hospital stay, types of herniated discs, complications, and clinical outcomes were evaluated. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified Macnab criteria. Short‐Form 36 (SF‐36) and the EQ‐5D‐5L were used to evaluate the quality of life of patients. The data between the two groups were compared by independent sample t‐tests. Multiple comparisons between samples were analyzed by analysis of variance.ResultsCompared with the MTD group, the PTED group had shorter incision length (9.20 ± 1.19 mm vs 26.38 ± 1.82 mm), less intraoperative blood loss (18.00 ± 4.97 mL vs 39.83 ± 6.51 mL), and shorter hospital stay (5.42 ± 5.08 days vs 10.58 ± 3.69 days) (P = 0.00). PTED was much more appropriate for foraminal and extraforaminal disc herniation. The incidence of paresthesia was lower in the PTED group (6.67% vs 16.67%). At each follow up, the VAS and ODI scores of all patients were significantly improved compared with those before surgery (P = 0.00). At 3 days postoperatively, the lumbar VAS score of the PTED group was significantly lower (1.58 ± 1.00 vs 2.37 ± 1.10, P = 0.00). The excellent rate of the PTED group reached 91.67%, and that of the MTD group reached 93.33%. Compared with the preoperative SF‐36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved in both groups (P = 0.00). The EQ‐5D‐5L in the PTED group increased from 0.30 ± 0.17 before the operation to 0.69 ± 0.13 after 6 months of follow up (P = 0.00) and 0.73 ± 0.14 after 20 months of follow up. The EQ‐5D‐5L in the MTD group increased from 0.28 ± 0.17 before the operation to 0.68 ± 0.13 after a 6‐month follow up (P = 0.00), and 0.73 ± 0.12 after a 20‐month follow up.ConclusionAlthough both PTED and MTD are effective for LDH, PTED is much more appropriate for various types of LDH and has the advantages of the low incidence of low back pain, fewer complications, and early recovery.     

腰椎间盘突出症合并椎管狭窄23 例治疗分析

目的探讨经后路椎间盘镜手术治疗合并腰椎管狭窄症的椎间盘突出症的临床应用。方法采用后路椎间盘镜进行单侧开窗减压术。通过术前标记腰椎正侧位片定位，于定位棘突间隙后正中偏患侧作长约1.5 cm小切口，逐级扩张后置入工作通道管，钻除部分椎板，置入内窥镜，于电视监视器下显露椎板、增生内聚的关节突、肥厚的黄韧带及突出的椎间盘髓核组织，彻底解除其对硬脊膜、神经根的压迫。结果本组共治疗合并腰椎管狭窄症的腰椎间盘突出症23例，平均随访7个月，按Prolo标准评定，治愈20例，有效2例，无效1例。结论本术式在严格掌握适应证前提下对合并腰椎管狭窄症的腰椎间盘突出症患者效果明显。     

经皮穿刺切吸治疗腰椎间盘突出症

方法：本文通过１９６例腰椎间盘突出症的ＡＰＬＤ治疗及平均１２个月的临床观察,优良率达９５．４％,从适应症选择,禁忌症,髓核切吸量与疗效关系,再次切吸问题,并发症发生及预防措施等方面,详细论述了该技术运用中的一些具体问题。强调了伴有椎间盘钙化和椎体后缘骨赘形成时,仍可选择就诊前病史中有缓解期,本次发病不超过６个月的病例做为适应症。结论：认为该技术与保守治疗,传统手术一样,将成为治疗腰椎间盘突出症的主