目的 探讨经皮椎间孔镜下椎板间入路(percutaneous endoscopic interlaminar discectomy， PEID) 治疗腰椎间盘突出症的手术并发症及防治方法。 方法 分析我院应用PEID治疗的 56例单节段腰椎间盘突出症患者, L4/5 30例, L5/S1 26例。采用术前、术后腰腿疼痛视觉模拟评分(visual analogue scale，VAS)， Oswestry 功能障碍指数(Oswestry disability index, ODI)及日本骨科学会(JOA)评分评估疗效。观察术中、术后并发症及处理方法。 结果 所有患者均获得随访，术后24 h 、3个月、12个月VAS评分、ODI及JOA评分均较术前显著改善。12例出现并发症，发生率为 21.43%。3例术中出现颈部疼痛, 通过改变灌注生理盐水压力缓解，1例会阴区麻木，4例腰痛, 2例下肢麻木乏力, 1例硬膜囊撕裂后改为开放小开窗手术，1例神经根不完全损伤, 术后均完全恢复。无感染,无腹膜及腹腔脏器损伤,无马尾神经损伤,无伤口愈合不良,术后1年无复发。 结论 PEID治疗腰椎间盘突出症近期疗效良好,也存在相关并发症, 术者需熟悉相应的预防措施。
Abstract
Objective To evaluate the surgical complications and prevention methods of percutaneous endoscopic interlaminar discectomy(PEID) for lumbar disc herniation. Methods Total of 56 cases with single-segment lumbar disc herniation underwent PEID surgery in our hospital were analyzed. The levels of herniation were L4/5 in 30 cases, L5/S1 in 26 cases. The visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and JOA scores at preoperative and postoperative were observed to evaluate the clinical effects. The complications during operation and post-operation were studied respectively. Results All cases were followed up, the VAS scores, ODI scores and JOA scores at 24 hours, 3 months and 12 months after operation were significantly improved as compared to those of pre-operative. The complications were found in 12 cases, with the incidence rate of 21.43%. In 3 cases, the neck pain was relieved by changing the pressure of the washing liquid, numbness of perineum was noted in 1 case, lumbago was noted in 4 cases and postoperative dysesthesia and weakness in 2 cases. Dural tear was found in 1 case, who recovered after posterior open lumbar discectomy immediately. 1 case had partial nerve root injury. All of the patients were recovered. There were no infection, no peritoneal and abdominal organ damage, no cauda equina nerve damage, no bad wound healing and no recurrence 1 year after operation. Conclusions PEID has a good short-term effect in the treatment of lumbar disc herniation, but also has related complications. The operator should understand the possible complications and take corresponding preventive measures.
关键词
腰椎间盘突出症 /
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经皮内窥镜下腰椎间盘切除术 /
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椎板间入路 /
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并发症
Key words
Lumbar disc herniation /
Percutaneous endoscopic lumbar discectomy /
Interlaminar approach /
Complication
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基金
广东省医学科研基金项目（B2018195）; 佛山市科技局医学攻关项目（201308334）
京ICP备08002354号-3
