Wang Dong, Xu Jin-Chao, Cheng Wei, Gao Wen-Shuo, Bao Jian-Hang, Zhu Li, Hu Qing-Feng, Pan Hao
Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China.
Zhongguo Gu Shang. 2021 Jul 25;34(11):994-1001. doi: 10.12200/j.issn.1003-0034.2021.11.002.
To investigate the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) through bone tunnel in the treatment of migrated lumbar intervertebral disc herniation.
The clinical data of 42 patients with migrated lumbar intervertebral disc herniation treated through PELD techniques were retrospectively analyzed from October 2015 to December 2018. There were 26 males and 16 females, aged from 39 to 71 years old with a mean of(58.55±7.16) years. There were 7 cases where the affected segment was L, 24 cases of L, and 11 cases of LS. According to modified free nucleus pulposus classification, 3 cases of type A1, 6 cases of type A2, 8 cases of type B1, 8 cases of type B2, 6 cases of type C1, and 11 cases of C2. Among these 42 cases, 22 patients were treated with transpedicular approach (transpedicular approach group), 6 cases were type A2, 6 cases were type B2 and 10 cases were type C2, and 20 cases with translaminar approach(translaminar approach group), 3 cases were type A1, 8 cases were type B1, 6 cases were type C1, 2 cases were type B2 and 1 case was type C2. The operation time, intraoperative and postoperative complications of the two groups were recorded, and the pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess the improvement of the clinical symptoms before surgery, immediately after surgery, and 12 months after surgery, and the modified Macnab evaluation system was used to evaluate the clinical efficacy.
The operative time was from 69 to 105 min with a mean of (88.29±9.85) min;and no intraoperative complications such as neurovascular injury or dural tear were occurredin all patients. One case in the transpedicular approach group was changed to general anesthesia and translaminar approach due to local anesthesia intolerance. All the patients were followed up from 13 to 34 months, with a mean of (13.71±3.56) months. VAS and ODI were significantly improved in two groups immediately after surgery and 12 months after surgery (P<0.05). According to modified Macnab criteria, 27 cases obtained excellent results, 11 good, 3 fair, and 1 poor. There were no postoperative complications such as lumbar fractures and postoperative infections in the follow-up patients.
For migrated intervertebral disc herniation, the modified nucleus pulposus classification can be used to estimate the precise target before operation, and the reasonable bone tunnel approach can be selected to obtain good results.
探讨经皮内镜下经骨隧道腰椎间盘切除术（PELD）治疗游离型腰椎间盘突出症的临床效果。
回顾性分析2015年10月至2018年12月采用PELD技术治疗的42例游离型腰椎间盘突出症患者的临床资料。其中男26例，女16例，年龄39～71岁，平均（58.55±7.16）岁。病变节段L₄ 7例，L₅ 24例，L₅S₁ 11例。根据改良游离髓核分类，A1型3例，A2型6例，B1型8例，B2型8例，C1型6例，C2型11例。42例中，22例采用经椎弓根入路（经椎弓根入路组），A2型6例，B2型6例，C2型10例；20例采用经椎板间入路（经椎板间入路组），A1型3例，B1型8例，C1型6例，B2型2例，C2型1例。记录两组手术时间、术中及术后并发症，采用疼痛视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估术前、术后即刻及术后12个月临床症状的改善情况，采用改良Macnab评价系统评估临床疗效。
手术时间69～105 min，平均（88.29±9.85）min；所有患者术中均未发生神经血管损伤、硬膜撕裂等并发症。经椎弓根入路组1例因局部麻醉不耐受改为全身麻醉并采用经椎板间入路。所有患者随访13～34个月，平均（13.71±3.56）个月。两组术后即刻及术后12个月VAS和ODI均显著改善（P<0.05）。根据改良Macnab标准，优27例，良11例，可3例，差1例。随访患者未发生腰椎骨折、术后感染等术后并发症。
对于游离型腰椎间盘突出症，改良髓核分类可用于术前精确靶点估计，选择合理的骨隧道入路可取得良好效果。
