经皮内镜下腰椎间盘切除术治疗慢性盘源性下腰痛
[Percutaneous endoscopic lumbar discectomy for treatment of chronic discogenic low back pain].
作者信息
Wang Jian, Zhou Yue, Li Changqing, Zhang Zhengfeng, Zhang Nianchun
机构信息
Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, PR China.
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr;23(4):400-3.
OBJECTIVE
To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and failing to respond to conservative treatment.
METHODS
From June 2007 to May 2008, 52 patients with CLBP and failing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed with discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months. MRI exam revealed 108 "black intervertebral discs" low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The clinical outcome was determined by modified Macnab criteria at the final follow-up.
RESULTS
The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No complications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment. Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 +/- 1.52), (3.62 +/- 0.92) and (1.57 +/- 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P < 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%.
CONCLUSION
Preliminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and failing to respond to conservative treatment.
目的
评估经皮内镜下腰椎间盘切除术（PELD）治疗椎间盘源性慢性下腰痛（CLBP）且保守治疗无效患者的初步临床疗效。
方法
2007年6月至2008年5月，对52例CLBP且保守治疗无效的患者进行治疗，其中男性15例，女性37例，年龄29 - 46岁（平均38.2岁）。这些患者经低压椎间盘造影诊断为椎间盘源性疼痛。CLBP病程为6 - 110个月，平均32.1个月。MRI检查显示108个在T2图像上信号低的“黑色椎间盘”，其中L2,3椎间盘3个，L3,4椎间盘17个，L4,5椎间盘48个，L5 - S1椎间盘40个。压力控制椎间盘造影显示阳性反应，透视或术中CT证实79个椎间盘纤维环后部撕裂。实施PELD。在术前、术后1个月及最终随访时评估视觉模拟评分（VAS）。在最终随访时根据改良Macnab标准确定临床疗效。
结果
每个椎间盘平均手术时间为30.7分钟（范围21 - 36分钟），术后平均住院时间为3.7天（范围2 - 5天）。未发生感染及血管、神经损伤等并发症。5例患者在手术当日出现短暂性神经麻痹，这些症状在最终随访时未经特殊治疗而消失。52例患者随访3 - 15个月（平均7.3个月）。术前、术后1个月及最终随访时VAS评分分别为（7.34±1.52）、（3.62±0.92）和（1.57±0.48）分，与术前评分相比差异有统计学意义（P < 0.01）。根据改良Macnab标准，优11例，良23例，可13例，差5例，优良率为65.38%。
结论
初步研究表明，PELD治疗椎间盘源性CLBP且保守治疗无效的患者安全有效。
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