显微镜辅助下经固定通道手术治疗巨大游离脱垂型腰椎间盘突出症的疗效分析

目的 探讨显微镜辅助下经固定通道治疗巨大游离脱垂型腰椎间盘突出症的可行性及其临床疗效。方法 回顾性分析2016年8月—2017年4月,大连医科大学附属第一医院脊柱外科采用显微镜辅助下经固定通道治疗36例巨大游离脱垂型腰椎间盘突出症患者的临床资料。其中男21例、女15例,年龄21~58岁。病变节段:L_3/4 7例,L_4/5 19例,L₅/S₁ 10例。比较患者手术前后腰腿疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),并采用改良MacNab标准评价临床疗效。结果 所有患者顺利完成手术。手术时间(45±9)min,术中平均出血量20 mL,术中平均X线机透视3次。患者术后腰腿痛,肌力减退、感觉减退以及大小便功能障碍均有不同程度的缓解。术前、术后第1天及术后1、3、6个月腰痛VAS分别为(5.8±1.2)、(1.8±0.8)、(1.2±0.6)、(0.6±0.3)和(0.5±0.3)分,腿痛评分分别为(7.8±1.2)、(2.8±0.6)、(1.7±0.4)、(0.7±0.2)和(0.6±0.1)分;术前及术后1、3、6个月ODI分别为52.57%±9.21%, 34.27%±7.58%, 24.45%±6.78%和12.56%±5.21%;术前与术后各时点腰VAS及ODI比较,差异均有统计学意义(P值均<0.01)。末次随访时改良MacNab评价疗效,优良率94.4%(34/36)。结论 显微镜辅助下经固定通道治疗巨大游离脱垂型腰椎间盘突出症具有创伤小、出血少、术中透视少等优点,其近期疗效确切,远期结果有待进一步随访。

Effects analysis of massive sequestrated prolapse of lumbar disc herniation assisted by microscope via fixed channel

Objective To investigate the clinical effect of microscope assisted by fixed channel on the treatment of massive sequestrated prolapse of lumbar disc herniation. Methods From August 2016 to April 2017, 36 patients of massive sequestrated prolapse of lumbar disc herniation in the Department of Spinal Surgery of the First Affiliated Hospital of Dalian Medical University were treated with microscope assisted by fixed channel. Among them, there were 21 males and 15 females, aged 21-58 years, with an average of 37 years. Segment L_3/4:7, L_4/5:19 and L₅/S₁:10. The clinical efficacy was evaluated by pain visual analogue score (VAS), Oswestry dysfunction index (ODI) and improved MacNab. Results The operation was performed successfully for all the patients. The mean operation time was (45±9) min, and the average bleeding amount was 20 mL. The average frequency of fluoroscopy was 3 times in each operation. Dysfuncton of stool, sensory disturbance, muscle weakness, and low back and leg pain were alleviated in different degrees after the operation in all the patients. Preoperative, postoperative 1 day, 1 month, 3 months, and 6 months back pain VAS scores were 5.8±1.2, 1.8±0.8, 1.2±0.6, 0.6±0.3, and 0.5±0.3, respectively. Leg pain scores were 7.8±1.2, 2.8±0.6, 1.7±0.4, 0.7±0.2, and 0.6±0.1 points, respectively. The ODI indexes were 52.57%±9.21%, 34.27%± 7.58%, 24.45%±6.78%, and 12.56%±5.21%, respectively. Statistically significant differences existed in the VAS and ODI scores preoperatively and in the corresponding follow-up time (all P values＜0.01). The improved MacNab was evaluated at the last follow-up, with a good rate of 94.4%(34/36). Conclusions The treatment of massive sequestrated prolapse of lumbar disc herniation assisted by microscope via fixed channel has advantages of less trauma, less bleeding and less intraoperative fluoroscopy. Its short-term curative effect is accurate. Long-term results need further follow-up.