后路脊柱全内镜结合类固醇激素鞘内注射手术治疗腰椎间盘突出症

目的探讨腰椎间盘内镜技术(microendoscopic disectomy,MED)结合类固醇激素神经根鞘内注射治疗腰椎间盘突出症的效果。方法 2010-02—2012-12收治的60例腰椎椎间盘突出患者随机分为MED组30例,行MED手术,MED神经根鞘内注射组治疗30例,行MED手术并在神经根鞘杰注入5 mg地塞米松。记录两组手术前后疼痛视觉模拟量表(visualanalogue scale,VAS)评分、直腿抬高角度及术后恢复正常工作的时间,术中、术后并发症发生情况。结果与治疗前比较,两组患者治疗后VAS评分明显减低,直腿抬高角度明显升高,差异有统计学意义(P0.05);与MED组比较,MED神经根鞘内注射组患者治疗后VAS评分及直腿抬高角度的改变更明显,差异有统计学意义(P0.05);MED神经根鞘内注射组患者治疗后恢复正常工作时间明显短于MED组患者(P0.05);MED神经根鞘内注射组患者出现2例并发症,发生率6.7%,术中硬脊膜撕裂并出现脑脊液漏1例,术后因侧隐窝减压不充分和瘢痕粘连再手术1例;MED组患者出现切口感染1例,发生率为3.3%(P0.05)。结论后路脊柱显微内镜结合鞘内注射类固醇激素治疗腰椎椎间盘突出,能显著改善术后疼痛、恢复肢体活动范围及更早的恢复日常生活。

Functional outcomes of posterior full microendoscopic discectomy with steroid intrathecal injection in nerveroot for Lumber disc herniation

Objective To observe the effect of steroid intrathecal injection in nerve root during posterior Mieroendoscopic disectomy （MED） for Lumber disc herniation. Methods Sixty paitients with Lumber disc herniation were selected randomly and grouped as MED group （n = 30） and MEDwith intrathecal injection group（ n = 30） from February of 2012 to December of 2013. The MED group patients were treated with MED,and the MEDwith intrathecal injection group were treated with MED with intrathecal injection（ dexamethasone 5 mg ）. Visual analogue scale （VAS） score, straight leg raising angle, the duration of recovery and the complication were observed and recorded before and after the treatment in both groups. Results Compared with the before the treatment, the VAS scores of two group were diseased remarkably, and the straight leg raising angle were increased, which were difference significantly （ P 〈 0. 05 ） ; Compared with the MED group, the VAS score and straight leg raising angle in MED with intrathecal injection group were improved remarkably, which were difference significantly （ P 〈 0.05 ） ; The complications of MED with intrathecal injection group were two cases （6.7%）, which included Tear of the stiff backbone of cerebrospinal fluid leakage and second operation for Inadequate lateral crypt decompression and scar adhesions;and the complication of MED group was one case （3.3%）, which was infection of incisional wound, the complication rate in two groups was no difference significantly （ P 〉 0. 05 ）. ConclusionMED with steroid intrathecal injection in the treatment of lumbardisc herniation can effectively relieve the postoperative pain. Restore the range of motion and make patients early return to normallire.