摘要: |
目的:探讨PTES(percutaneous transforaminal endoscopic surgery)椎间孔镜技术治疗腰5/骶1椎间盘突出症的手术技巧及疗效。方法:选取2012年11月至2013年4月使用PTES椎间孔镜技术治疗的腰5/骶1椎间盘突出症患者52例,其中伴高髂嵴24例,均无中央椎管骨性狭窄及椎间不稳。记录手术时间、术中透视次数、出血量、住院天数;对术前、术后即刻及术后1周、1个月、2个月、3个月、6个月、1年、2年的下肢疼痛情况进行视觉模拟评分法(VAS)评分;术后2年,用Macnab法进行疗效评级,观察术后有无并发症发生。 |
关键词: 腰椎间盘突出症 经皮内镜下髓核摘除术 经椎间孔 腰5/骶1 髂嵴 |
DOI:10.12025/j.issn.1008-6358.2017.20170060 |
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Abstract: |
Objective:To investigate the technique and efficacy of PTES for treatment of L5/S1 disc herniation. Methods:PTES was performed on 52 cases of L5/S1 herniations without spinal instability and central spinal canal stenosis, including 24 cases of high iliac crest, from November 2012 to April 2013. The operation duration, frequency of intraoperative fluoroscopy, blood loss and hospitalization days were recorded. Leg pain was evaluated by using the visual analog scale (VAS) Preoperatively and immediately, 1 week, 1 month, 2 months, 3 months, 6 months, 1 year and 2 years after surgery. The results were determined to be excellent, good, fair, or poor according to the Macnab classification, and complications were observed at 2 year follow up. Results:The mean operation duration was (56.3±11.5) min per segment. The median frequency of intraoperatively fluoroscopy was 5 (3-14) times. The median blood loss was 5 (2-20) mL. The median hospital stay was 3 (2-4) days. The average postoperative follow up was (26.2±2.0) months. The median preoperative VAS score of leg pain was 9 (6-10), 1 (0-3) immediately after the operation and 0 (0-3) 2 years after operation, and the differences were statistically significant (P<0.001). There were 3 cases of lower limb rebound pain 1 week after operation, which were relieved within 2 months after operation. The rate of excellent and good curative effect was 98.1% (51/52) 2 years after operation. No complications such as nerve injury, infection, abdominal organ damage and rupture of large vessels occurred. No recurrence occurred. Conclusions:PTES for L5/S1 disc herniation including the cases with high iliac crest is an easy, effective and safe technique. The method has the advantages of simple positioning, easy puncture, simple steps and less fluoroscopy, and the learning curve is not steep for surgeons. |
Key words: lumbar disc herniation percutaneous endoscopic lumbar discectomy transforaminal L5/S1 iliac crest |