经皮内镜下腰椎间盘摘除术后椎间盘残留影响及原因分析

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摘要

目的分析经皮内镜下腰椎间盘摘除术后椎间盘残留的原因。方法自2012年8月至2017年7月，应用经皮内镜治疗初患腰椎间盘突出症患者315例，其中男193例，女122例；年龄16~81岁，平均年龄43.5岁。单节段突出307例，双节段突出7例，3节段突出1例。椎板间隙入路102例，侧方入路213例。术后复查核磁或CT，按照是否存在残留分为残留组和无残留组，随访4个月～5年，对比分析两组的性别、年龄、手术入路、腰椎Oswestry功能障碍指数(oswestry disability index，ODI)、腰腿视觉模拟评分(visual analogue scale，VAS)等情况。结果共发生术后残留26例，残留发生率8.25%；女9例，男17例；全部为单节段病例，L₅S₁节段10例，L_4～5节段16例；椎板间隙入路7例，侧方入路19例；2例残留患者术后2周内二次内镜手术，其他均未行二次手术。残留组和无残留组的性别、年龄、手术入路、术前腰椎ODI评分及术前腰腿VAS评分情况比较，差异无统计学意义；两组术后腰椎ODI评分及术后腰腿VAS评分比较，差异有统计学意义。结论术后残留是经皮内镜下腰椎间盘摘除术的常见并发症，手术经验不足是残留发生的根本原因，残留患者的手术疗效欠佳，个别患者需要二次手术。

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	李大刚
	陈世忠
	周其璋

关键词 ：腰椎间盘突出症, 经皮, 椎间盘切除术, 内镜, 残留

Abstract：

Objective To analyze the cause of nucleus pulposus residue after percutaneous endoscopic lumbar discectomy(PELD).Methods From August 2012 to July 2017，315 patients with primary lumbar disc herniation(LDH) were treated with PELD.There were 193 males and 122 females.The patients aged from 16 to 81 years，with an average age of 43.5 years.307 patients had single level procedure，7 patients had double level procedure，and 1 patients had three level procedure.102 patients were treated by intralaminar approach，and 213 patients were treated by transforaminal approach.Lumbar MRI or CT was checked after the operation.According to the result of MRI or CT，The patients were divided into residue group or non-residue group.All patients were followed up for 4 months to 5 years.The gender，age，operation approach，0swestry disability index(ODI)，and visual analogue scale(VAS) were analyzed between the two groups.Results Nucleus pulposus residue happened in 26 patients and the incidence rate was 8.25%.There were 9 females and 17 males.All the patients had single level LDH，including 10 discs of L₅S₁ and 16 discs of L_4～5.7 patients were treated by intralaminar approach，and 19 patients were treated by transforaminal approach.Only 2 patients needed second procedure.There was no significant difference between the two groups in the gender，age，operation approach，ODI before operation，and VAS before operation.There was significant difference between the two groups in the ODI after operation，and VAS after operation.Conclusion Nucleus pulposus residue is a common complication after PELD.Insufficent surgical experience is the primary cause.Part of the patients are unsatisfied with the result，but few of the patients need second operation.

Key words： lumbar disc herniation pereutaneous discectomy endoscopic residue

基金资助:中山市科技局项目(2018B1097)

作者简介: 李大刚(1980－ )，男，副主任医师，广东中山市中医院骨一科，528400。

引用本文:

李大刚，陈世忠，周其璋. 经皮内镜下腰椎间盘摘除术后椎间盘残留影响及原因分析[J]. 实用骨科杂志, 2018, 24(12): 1061-1064.
Li Dagang，Chen Shizhong，Zhou Qizhang. Cause Analysis of Nucleus Pulposus Residue after Percutaneous Endoscopic Lumbar Discectomy. sygkzz, 2018, 24(12): 1061-1064.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2018/V24/I12/1061

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