[1]王小丽 白明亮 汤立琪 吴从俊△.经皮椎间孔镜治疗腰椎融合术后邻近节段腰椎退变19例[J].中国中医骨伤科杂志,2021,29(10):73-76.
　WANG Xiaoli BAI Mingliang TANG Liqi WU Congjun.19 Cases of Clinical Observation for Percutaneous EndoscopicLumbar Discectomy Treatment of Adjacent SegmentDegeneration after Lumbar Fusion[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2021,29(10):73-76.
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经皮椎间孔镜治疗腰椎融合术后邻近节段腰椎退变19例()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第29卷
期数:
2021年10期
页码:
73-76
栏目:
临床报道
出版日期:
2021-10-15

文章信息/Info

Title:
19 Cases of Clinical Observation for Percutaneous EndoscopicLumbar Discectomy Treatment of Adjacent SegmentDegeneration after Lumbar Fusion
文章编号:
1005-0205(2021)10-0073-04
作者:
王小丽1 白明亮1 汤立琪1 吴从俊2△
1洪湖市中医院骨一科(湖北 洪湖,433200)2湖北六七二中西医结合骨科医院
Author(s):
WANG Xiaoli1 BAI Mingliang1 TANG Liqi1 WU Congjun2△
1Department of Orthopedics and Traumatology,Honghu Hospital of Traditional Chinese Medicine,Honghu 433200,Hubei China; 2Department of Orthopedics and Traumatology,Hubei 672 Orthopedics Hospital of Integrated Chinese & Western Medicine,Wuhan 430079,China.
关键词:
内窥镜;  椎间盘突出;  微创
Keywords:
endoscope;  lumbar dise herniation;  minimal invasive
分类号:
R681.5
文献标志码:
B
摘要:
目的:探讨经皮内镜治疗腰椎融合术后邻近节段腰椎退变的近期临床疗效和安全性。方法:2017年1月至2019年1月19例既往行腰椎融合手术的患者,再次因单侧下肢疼痛入院,诊断为邻近节段腰椎间盘突出症,并在本院接受经皮内镜手术治疗。回顾性分析19例患者的临床资料,分别于术前、术后1、3、6、12个月及末次随访时采用疼痛视觉模拟评分(VAS)和Oswestry残疾指数(ODI)评估手术疗效,并在末次随访采用改良MacNab标准评估临床疗效。结果:19例患者均顺利完成手术,年龄52～71岁,平均(54.8±11.23)岁; 其中男11例,女8例; 随访时间为18～35个月,平均(22.56±6.72)个月; 手术时间为50～90 min,平均(55.56±10.38)min; 术中估计失血量为10～35 mL,平均(12.45±4.38)mL; 住院时间4～10 d,平均(5.74±1.19)d。术后腰、腿痛VAS及ODI评分均较术前明显提升,差异有统计学意义(P<0.01),末次随访改良MacNab标准评估手术疗效,其中优13例,良4例,可1例,差1例,优良率89.47%。结论:经皮椎间孔镜治疗腰椎融合术后邻近节段腰椎退变疗效确切,具有创伤小、恢复快、术后并发症少等优点,但具有一定的学习曲线,需要把握好适应证。
Abstract:
Objective:To observe the clinical effect and safety of percutaneous endoscopic treatment of lumbar disease in adjacent segments after lumbar fusion.Methods:From January 2017 to January 2019,19 patients who had underwent lumbar fusion surgery were admitted to hospital for unilateral lower extremity pain again diagnosed as adjacent lumbar disc herniation,and received percutaneous endoscopic surgery in our hospital.The clinical data of 19 patients were analyzed retrospectively.The pain visual analogue score(VAS)and Oswestry disability index(ODI)were used in the preoperative,1,3,6,12 months after operation and the last follow-up.The ODI was used to evaluate the surgical efficacy and the modified MacNab standard was used to evaluate the clinical efficacy at the last follow-up.Results:All 19 patients were successfully operated.The age of whom was 52 to 71 years old.The average age was(54.8±11.23)years old,including 11 males and 8 females.The follow-up period was 18 to 35 months.The average follow-up time was(22.56±6.72)months.The operation time was 50 to 90 min.The average operation time was(55.56±10.38)min.The estimated blood loss was 10 to 35 mL.The average blood loss was(12.45±4.38)mL.The hospitalization time was 4 to 10 d.The average time was(5.74±1.19)d.The VAS of lumbar and leg pain and ODI scores after operation were significantly improved(P<0.01)as compared with those before surgery.According to the modified MacNab criteria in the last follow-up,13 cases were excellent,4 cases were good,1 case was fair and 1 case was poor.The excellent and good rate was 89.47%.Conclusion:Percutaneous endoscopic lumbar discectomy is effective in the treatment of lumbar degeneration in the adjacent lumbar disc herniation after fusion surgery,which has the advantages of small trauma,fast recovery and less postoperative complications,but it needs a certain long learning curve and indications control.

参考文献/References:

[1] WILCKE M K,HAMMARBERG H,ADOLPHSON P Y.Epidemiology and changed surgical treatment methods for fractures of the distal radius:a registry analysis of 42,583 patients in Stockholm County,Sweden,2004-2010[J].Acta Orthop,2013,84(3):292-296.
[2] ZHANG X,ZHU J,LI Y,et al.A modified method to treat severe asymptomatic pre-existing degeneration of adjacent segment:a retrospective case-control study[J].BMC Surg,2021,21(1):161.
[3] HEI L,GE Z,YUAN W,et al.Evaluation of a rabbit model of adjacent intervertebral disc degeneration after fixation and fusion and maintenance in an upright feeding cage[J].Neurol Res,2021,43(6):447-457.
[4] SHIN E H, CHO K J, KIM Y T,et al.Risk factors for recurrent lumbar disc herniation after discectomy[J].Int Orthop,2019,43(4):963-967.
[5] PAN M,LI Q,LI S,et al.Percutaneous endoscopic lumbar discectomy:indications and complications[J].Pain Physician,2020,23(1):49-56.
[6] PARK C H,PARK E S,LEE S H,et al.Risk factors for early recurrence after transforaminal endoscopic lumbar disc decompression[J].Pain Physician,2019,22(2):E133-E138.
[7] SELVA-SEVILLA C, FERRARA P, GERNIMO-PARDO M.Cost-utility analysis for recurrent lumbar disc herniation:conservative treatment versus discectomy versus discectomy with fusion[J].Clin Spine Surg,2019,32(5):E228-E234.
[8] AJIBOYE R M, DRYSCH A, MOSICH G M,et al.Surgical treatment of recurrent lumbar disk herniation:a systematic review and meta-analysis[J].Orthopedics,2018,41(4):e457-e469.
[9] GOKER B, AYDIN S.Endoscopic surgery for recurrent disc herniation after microscopic or endoscopic lumbar discectomy[J].Turk Neurosurg,2020,30(1):112-118.
[10] HASHIMOTO K, AIZAWA T, KANNO H,et al.Adjacent segment degeneration after fusion spinal surgery-a systematic review[J].Int Orthop,2019,43(4):987-993.
[11] WANG T,DING W.Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders:a meta-analysis[J].J Orthop Surg Res,2020,15(1):582.
[12] MARAGKOS G A, MOTIEI-LANGROUDI R, FILIPPIDIS A S,et al.Factors predictive of adjacent segment disease after lumbar spinal fusion[J].World Neurosurg,2020,133:e690-e694.
[13] 刘联群,陈长贤,王汉龙,等.经皮侧路椎间孔镜与后路椎板开窗术治疗腰椎间盘突出症的中期疗效观察[J].中国中医骨伤科杂志,2017,25(5):30-33.
[14] 高琨,胡美琴,刘亮,等.椎间孔镜治疗腰椎融合后相邻节段腰椎间盘突出症20例[J].中国中医骨伤科杂志,2018,26(7):71-73.
[15] HAMM-FABER T E, GüLTUNA I, VAN GORP E J,et al.High-dose spinal cord stimulation for treatment of chronic low back pain and leg pain in patients with FBSS,12-month results:a prospective pilot study[J].Neuromodulation,2020,23(1):118-125.
[16] KIM H S, PATEL R, PAUDEL B,et al.Early outcomes of endoscopic contralateral foraminal and lateral recess decompression via an interlaminar approach in patients with unilateral radiculopathy from unilateral foraminal stenosis[J].World Neurosurg,2017,108:763-773.
[17] 鲁尧,吴钊钿,李振宇,等.经皮侧路椎间孔镜治疗极外侧型腰椎间盘突出症35例[J].中国中医骨伤科杂志,2020,28(1):75-77.
[18] 刘镠,李莹,吴从俊,等.经皮内镜下腰椎间融合技术研究进展[J].中国中医骨伤科杂志,2019,27(11):85-88.
[19] LI X,HU Z,CUI J,et al.Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation[J].Int J Surg,2016,27:8-16.
[20] WANG H,ZHOU T,GU Y,et al.Evaluation of efficacy and safety of percutaneous transforaminal endoscopic surgery(PTES)for surgical treatment of calcified lumbar disc herniation:a retrospective cohort study of 101 patients[J].BMC Musculoskelet Disord,2021,22(1):65.

备注/Memo

备注/Memo:
基金项目:湖北陈孝平科技发展基金会临床研究基金
(CXPJJH12000005-07-10)
△通信作者 E-mail:wucongjun0402@163.com
更新日期/Last Update: 1900-01-01