CT三维重建经皮脊柱内镜治疗极外侧腰椎间盘突出症探讨

CT Three-Dimensional Reconstruction - Percutaneous Spinal Endoscopic Surgery for the Treatment of Extreme Lateral Lumbar Disc HerniationJun Yang(MD), Bing Ran(MD),XingRong Chen(MD), ,Qiong Zhong(MD) Min Fu(MD),

摘要:

目的：探讨CT三维重建经皮脊柱内镜手术治疗极外侧型腰椎间盘突出症的有效性及安全性。方法：2015年4月至2017年12月,对43例极外侧型腰椎间盘突出症患者采用CT三维重建导航经皮脊柱内镜手术治疗。评估患者术前、术后1天、1周、1月、6月VAS评分,术前、术后1月、6月、12月Oswestry功能障碍指数(Oswestr disability index,ODI),改良Macnab疗效评分评价患者术后1月、6月、12月优良率并观察相关并发症。结果：患者术前、术后1天、1周、1月、6月VAS评分分别为8.3±1.6、2.1±0.7、1.3±0.6、0.8 ±0.2、0.5±0.3术后各时期较术前比较差异有统计学意义(P<0．01),术前、术后1月、6月、12月ODI评分分别为75.6 ±12.7、18.3±7.3、16.8±5.5、10.8±3.2手术前后比较差异有统计学意义(P<0．01),患者术后1月、6月、12月MacNab优良率分别为88.4%(38/43),95.3%(41/43),95.3%(41/43) 。结论： CT三维重建导航-经皮脊柱内镜技术可更加精准、安全、有效治疗极外侧型腰椎间盘突出症。

Abstract:

Objective: To evaluate the efficacy and safety of CT Three-Dimensional Reconstruction - Percutaneous Spinal Endoscopic Surgery for the Treatment of Extreme Lateral Lumbar Disc Herniation (ELLDH).Methods: Forty-three patients with ELLDH from April, 2015 to December 2017 of our institute were enrolled in this study,which including 15 males and 28 females, and the average age is 58.6years±7.7years. All patients were treated by CT three-dimensional reconstruction guided full endoscopic surgery. The operation time and hospitalization days were recorded. CT-scan was immediately performed postoperative to assure that the disc herniation has been completely removed.The visual analog scale (VAS) was assessed preoperative and 1 day, 1 week, 1 month and 6 months postoperative and the Oswestr disability index(ODI) was assessed preoperative,1 month,6 months and 12 months postoperative.The modified Macnab score also been evaluated at 1month, 6 months and 12months posoperative. Results: All patients were successful treated operation.The symptom was significantly improved. The VAS score was decreased from 8.3 ± 1.6(preoperative) to 2.1 ± 0.7(1 day postoperative), 1.3 ± 0.6(1 week postoperative),0.8 ±0.2(1 month postoperative),0.5±0.3(6 months postoperative), respectively(P < 0.05). The ODI improved from 75.6 ±12.7(preoperative) to 18.3 ± 7.3 (1 month postoperative),to 16.8±5.5(6 months postoperative) and 10.8±3.2(12 months postoperative), respectively. The difference was statistically significant (P < 0.05). The MacNab excellent rate was 88.4%(1 month postoperative),95.3% (6 months postoperative) and 95.3%(12 months postoperative). Conclusion: The Treatment of CT Three-Dimensional Reconstruction - Percutaneous Spinal Endoscopic Surgery for Extreme Lateral Lumbar Disc Herniation is safe and effective. The residual probability of lumbar spine herniation is decreased. This good auxiliary can overcome incomplete endoscopic surgical field and reduce the possibility of postoperative symptoms relapse.