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改良经椎板骨通道辅助经皮内镜下腰椎间盘切除术治疗上腰椎高度移位和游离型椎间盘突出症:临床疗效、手术指征及技术要点

A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations.

作者信息

Xin Zhijun, Liao Wenbo, Ao Jun, Qin Jianpu, Chen Fang, Ye Zhiyuan, Cai Yuqiang

机构信息

Department of Spinal Surgery, The First Affiliated Hospital of Zunyi Medical College, Zunyi, China.

出版信息

Biomed Res Int. 2017;2017:3069575. doi: 10.1155/2017/3069575. Epub 2017 Mar 30.

Abstract

Objective is to describe a safe and effective percutaneous endoscopic approach for removal of highly migrated and sequestrated disc herniations of the upper lumbar spine and to report the results, surgical indications, and technical considerations of the new technique. Eleven patients who had highly migrated and sequestrated disc herniations in the upper lumbar were included in this study. A retrospective study was performed for all patients after translaminar osseous channel-assisted PELD was performed. Radiologic findings were investigated, and pre-and postoperative visual analog scale (VAS) assessments for back and leg pain and Oswestry disability index (ODI) evaluations were performed. Surgical outcomes were evaluated under modified MacNab criteria. All of the patients were followed for more than 1 year. The preoperative and postoperative radiologic findings revealed that the decompression of the herniated nucleus pulposus (HNP) was complete. After surgery, the mean VAS scores for back and leg pain immediately improved from 8.64 (range, 7-10) and 8.00 (range, 6-10) to 2.91 (range, 2-4) and 2.27 (range, 1-3), respectively. The mean preoperative ODI was 65.58 (range, 52.2-86), which decreased to 7.51 (range, 1.8-18) at the 12-month postoperative follow-up. The MacNab scores at the final follow-up included nine excellent, one good, and one fair. The modified translaminar osseous channel-assisted PELD could be a safe and effective option for the treatment of highly migrated and sequestrated disc herniations of the upper lumbar.

摘要

目的是描述一种安全有效的经皮内镜方法,用于去除上腰椎高度移位和游离的椎间盘突出症,并报告新技术的结果、手术适应证和技术要点。本研究纳入了11例上腰椎高度移位和游离椎间盘突出症患者。对所有患者在进行经椎板骨通道辅助经皮内镜腰椎间盘切除术(PELD)后进行回顾性研究。调查影像学结果,并对患者术前和术后的背部和腿部疼痛视觉模拟量表(VAS)评估以及Oswestry功能障碍指数(ODI)进行评估。根据改良MacNab标准评估手术结果。所有患者均随访1年以上。术前和术后影像学结果显示,突出的髓核(HNP)减压完全。术后,背部和腿部疼痛的平均VAS评分立即从8.64(范围7 - 10)和8.00(范围6 - 10)分别改善至2.91(范围2 - 4)和2.27(范围1 - 3)。术前平均ODI为65.58(范围52.2 - 86),术后12个月随访时降至7.51(范围1.8 - 18)。末次随访时MacNab评分包括9例优、1例良和1例可。改良经椎板骨通道辅助PELD可能是治疗上腰椎高度移位和游离椎间盘突出症的一种安全有效的选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f335/5390599/8dc36d4bac8a/BMRI2017-3069575.001.jpg

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