腰椎间盘突出症椎间孔镜治疗后复发的术式选择及-第三军医大学学报.docVIP

腰椎间盘突出症椎间孔镜治疗后复发病例的 微创术式选择及临床应用 上官磊,? 宁广智,?李长青,? 周跃第三军医大学附属新桥医院骨科 【摘要】 目的: 评价腰椎间盘突出症患者椎间孔镜治疗后突出复发的微创翻修术式，并评估其临床疗效。方法:共3例椎间孔镜治疗后腰椎间盘突出复发患者, 男0例，女3例，平均50.8岁。其中0例患者获得随访（随访率94.1%）,随访时间平均随访.9月。临床患者被分为三组：再次行椎间孔镜下髓核摘除组(20例)、后路行椎间盘镜下髓核摘除术组（1例）和经Quadrant通道下TLIF组(1例)。疗效评定按照目测视觉类比评分法(VAS评分)）、Nakai分级。结果: 三组患者术后VAS显著降低，手术前后有显著（p＜0.05），三组之间比较无差异（p＞0.05）。根据Nakai分级；椎间孔镜组优良率% ,椎间盘镜组优良率%，经Quadrant通道下TLIF组优良率9.3%。虽然三组优良率间比较无统计学意义（p＞0.05）,但组的手术时间、术中出血量、术后下床时间都显著低于组。结论 : 椎间孔镜下行腰椎间盘突出复发翻修术非常有效和安全,仍然是腰椎间盘突出复发的首选术式。【】 strategies and options for recurrent lumbar disc herniation after the treatment of percutaneous endoscopic lumbar discectomy. SHANGGUAN Lei, NING Guang-zhi, LI Chang-qing, ZHOU Yue. Department of Orthopaedics, Xinqiao Hospital, the Third Military Medical University, Chongqing 400037, China Corresponding author：ZHOU YueEmail：Happyzhou@【Abstract】 Objective To evaluate the results of minimally invasive revision surgery for recurrent disc herniation. Methods: A total of 53 patients who had undergone revision surgery for recurrent disc herniation after the treatment of percutaneous endoscopic lumbar discectomy has been surveyed to assess their clinical outcome. The 50 patients who had been followed were divided into three groups: 20 cases received percutaneous endoscopic lumbar l discectomy alone, 18 cases received microendoscopic discectomy alone and 15 cases received microendoscopic discectomy with interbody fusion. With an average follow-up of 16.9 months after revision surgery. Clinical symptoms were assessed based on the VAS score、ODI index and Nakai criteria. All medical and surgical records were examined and analyzed, including intraoperative blood loss, length of surgery, and postsurgery hospital stay et al. Results: The statistical difference in the postoperative VAS score and ODI index compared with that of preoperative was significant(P0.05). Clinical outcomes were excellent or good in 85% of patients undergoing percutaneous endoscopic lumbar discectomy alone, in 88