经皮椎间孔镜椎间盘切除术治疗青年腰椎间盘突出症

目的评价经皮椎间孔镜腰椎间盘切除术(PELD)治疗经保守治疗无效的青年腰椎间盘突出症的临床效果。方法 10例经保守治疗无效的青年腰椎间盘突出症患者,经椎间盘造影证实12个椎间盘后方纤维环均撕裂,行PELD治疗。比较术前、术后疼痛视觉模拟评分(VAS)和术前、末次随访时Oswestry功能障碍指数(ODI),按改良Macnab标准评价临床疗效。结果手术时间30~60(42±15.5)min。住院时间5~7(5.6±0.7)d。10例均获随访,时间12~20(15.4±3.3)个月。术中未发生脑脊液漏、脊髓神经损伤。VAS术前为6~9(7.5±0.8)分,术后为0~3(1.4±0.8)分,差异有统计学意义(P0.01)。ODI术前为40.0%~82.9%(74.6%±13.1%),末次随访时为8.6%~14.3%(12.0%±3.2%),差异有统计学意义(P0.01)。根据改良Macnab标准:优2例,良7例,可1例。结论 PELD治疗经保守治疗无效的青年腰椎间盘突出症患者具有创伤小、恢复快、住院时间短等特点,疗效较好。

Percutaneous endoscopic lumbar discectomy for treatment of young patient with lumbar disc herniation

Objective To evaluate the clinical outcomes of percutaneous endoscopic lumbar discectomy （PELD） for young patient with lumbar disc herniation failing to conservative treatment. Methods 10 young patients with lumbar disc herniation failing to conservative treatment were treated. Discography showed positive response, fluoroscopy confirmed annulus fibrosus tears of posterior intervertebral disc in 12 discs. PELD was performed. Visual analogue scale （VAS） and Oswestry disability index（ODI） were evaluated before operation and after operation. The clinical outcome was determined by modified Macnab criteria at the final follow-up. Results The operation time was 30 - 60 （42 ± 15.5 ） minutes, and length of hospital stay was 5 - 7 （5.6 ±0. 7 ） days. 10 cases were followed up for 12 - 20 （ 15.4 ±3. 3） months. There was no ruptured meninges and nerve damage. VAS score before operation, after operation were 6 - 9（7. 5 ±0. 8 ） and 0 - 3 （ 1.4 ±0. 8 ） scores respectively, indicating there were significant differences compared with preoperative score （ P 〈 0.01 ）. ODI before operation, at the final follow-up were 40. 0% - 82. 9% （74. 6% ± 13.1% ） and 8. 6% - 14. 3% （ 12. 0% ±3.2% ） respectively, indicating there were significant differences compared with preoperative scores （P 〈 0. 01 ）. According to the modified Macnab criteria, 2 cases were graded as excellent, 7 as good, 1 as fair. Conclusions PELD is effective in treating young patient with lumbar disc herniation failing to conservative treatment. It has the advantages of less trauma, quick recovery and less length of hospital stay, it is a truly minimally invasive procedure.