摘要:
目的 分析经皮内窥镜下腰椎间盘摘除术(PELD)治疗腰椎间盘突出症的临床疗效.方法 采用PELD治疗389例腰椎间盘突出症患者.记录手术时间、住院天数,评价临床疗效(改良MacNab标准),分析PELD失败原因.结果 手术时间45~120 min,住院时间3~7 d.389例均获得随访,时间24~65个月.临床疗效优良率89.5%(348/389);失败率4.6%(18/389).18例失败病例中,椎间盘摘除不完全者10例,复发者4例,术后顽固性疼痛者3例,神经根损伤者1例.10例椎间盘摘除不完全者中,工作通道位置不适宜者3例,游离型者2例,中央型椎间盘突出者2例,腋下型者2例,肩型者1例.3例顽固性疼痛者经MRI及CT检查显示腰椎间盘摘除完全,但是有侧隐窝狭窄.结论 采用PELD治疗腰椎间盘突出症,可获得满意的临床疗效,但需根据椎间盘突出类型个体化对待.%Objective To analyze the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for treatment of lumbar disc herniation.Methods The 389 patients with lumbar disc herniation had undergone PELD.The operation time and hospital stay were recorded,clinical outcomes (using modified MacNab criteria) was evaluated,and the reason of failure was analyzed.Results Operative time was 45~120 min;hospitalization time was 3~7 d.All of 389 patients were followed up for 24~65 months.The rate of excellent-good was 89.5% (348/389);the failure rate of PELD was 4.6% (18/389).The reasons of failure as following:incomplete removal of herniated disc material in 10 patients,recurrence in 4 patients,postoperative persistent pain in 3 patients,nerve root injury in 1 patient.The reasons of incomplete removal of herniated disc material as following:technically inappropriate positioning of the working channel in 3 patients,migrated discs herniation in 2 patients,central disc in 2 patients,axillary type in 2 patients,and shoulder type in 1 patient.Three patients with persistent pain,the MRI and CT examination showed that they were completely removed the intervertebral disc and associated with lateral recess stenosis.Conclusions For disc herniation,using PELD can obtain satisfactory clinical efficacy,however,successful PELD requires techniques tailor-made to remove the herniated disc fragments in various types of disc herniations.