临床医学论文-经皮内镜椎间孔入路治疗极外侧腰椎间盘突出症.doc

临床医学论文-经皮内镜椎间孔入路治疗极外侧腰椎间盘突出症 ????????????? 作者：张长江，任文杰，王明君，张凯，李洪珂，董胜利，刘帅 【摘要】? 目的 探讨经皮内镜椎间孔入路治疗极外侧腰椎间盘突出症(FLDH)的安全性和疗效。方法 自2007年12月至2009年3月，16例被确诊为FLDH患者采用局部麻醉，在C臂X线机引导下采用经皮内镜椎间孔入路技术，直视下气化切除压迫神经根的极外侧突出的髓核组织，减压和松解受累神经根。采用视觉模拟评分法(VAS)对术前、术后1个月及末次随访患者疼痛状况进行评分，末次随访同时采用改良Macnab标准进行疗效评价。结果 所有手术均顺利完成，手术时间40～90 min，平均65 min;出血量20～180 ml，平均40 ml;术中、术后均无任何并发症发生。随访2～12个月，平均4个月，采用VAS评分评定，术后1个月及末次随访时与术前比较VAS评分差异均有显著统计学意义(P0.01);按照Macnab标准评定，本组优12例，良2例，可2例。结论 应用经皮内镜椎间孔入路治疗FLDH安全有效的微创手术，值得推广。 【关键词】? 经皮，内镜;椎间孔;极外侧腰椎间盘突出症 　　[Abstract] Objective To evaluate the safety and efficacy of treatment for far lateral lumbar disc herniation(FLDH) approach by the intervertebral foramen with percutaneous endoscopic lumbar discectomy(PELD).Methods From December 2007 to March 2009，16 patients which included 11 males and 5 females with average age of 43.5 years(range from 32 to 56 years)were treated by the intervertebral foramen with percutaneous endoscopic lumbar discectomy，and the nerve root decompression were analyzed.Results All the cases underwent the operation successfully and were followed up for a period of 2～12 months，operative time was 40～90 minutes，and the blood loss was 20～140 ml.No complications occurred.The Visual analog scale(VAS)scores of preoperation，1 month after operation and last follow-up were significantly different (P0.01).The clinical outcomes were assessed by Macnab criteria，12 cases were excellent，2 cases were good and 2 cases were effective.Conclusion Treatment of FLDH approach by the intervertebral foramen with PELD is safe and effective,minimally invasive surgery，it is worth promoting. 　　[Key words] percutaneous，endoscopy;intervertebral foramen;far lateral lumbar disc herniation 　　极外侧型腰椎间盘突出症(FLDH)在临床上较为少见，易误诊，是椎间盘突出症手术效果失败的原因之一[1]。传统的治疗方法不仅创伤大，且带来或加重腰椎的失稳，导致或加重患者术后的腰骶部疼痛。2007年12月至2009年3月平顶山煤业集团总医院应用经皮内镜经椎间孔入路治疗FLDH 16例， 　　取得了较好的临床效果，现报告如下。 　　1 资料与方法 　　1.1 一般资料 本组患者共16例，男11例，女5例，年龄32～56 岁，平均43.5岁。9例无腰椎间盘开放手术史，7例为单侧小开窗突出髓核摘除术后疗效不佳者;均经过保守治疗，且疗效不佳或症状持续加重;病变椎间隙分布情况：L2/31例，