| 摘要: |
| ［摘要］目的 探讨经皮脊柱内窥镜下治疗腰椎间盘突出症的手术策略及临床效果．方法 选择2013年8月至2015年10月收治的200例L4-L5节段椎间盘突出症患者，采用经皮脊柱内窥镜下手术治疗．男124例，女76例，平均年龄41岁，均存在明显腰腿痛．在局麻及影像学监视下采用神经根肩部或腋部入路，经皮脊柱内窥镜下完成突出或蜕变腰椎间盘髓核摘除术．采用视觉模拟评分法（visual analogue scale，VSA评分）、Oswestry功能障碍指数等评价疗效．结果 196例随访9～24个月，平均13.5个月，术前腰腿痛VSA评分为7.5±1.8，术后3个月为（3.0±1.5），术后6个月为（2.8±1.3），术后12个月为（2.0±1.5），手术前后有显著性差异（P＜0.01）；术前ODI为（58.5±17.8）%，术后3个月为（29.3±10.5）%，术后6个月为（20±7.5）%，术后12个月为（15.6±6.4）%，手术前后有显著性差异（P＜0.01）．结论 经皮脊柱内窥镜下治疗L4-L5节段间盘突出症，通过神经根肩部或腋部入路手术减压彻底、疗效显著，术前正确选择患者及充分影像评估是保证手术成功的关键． |
| 关键词: ［关键词］内窥镜 微创治疗 腰椎间盘突出症 策略 |
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| 基金项目:［基金项目］云南省科技厅-昆明医科大学联合专项基金资助项目（2014CD206） |
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| The Strategy of Percutaneous Endoscopic Lumbar Discectomy for Treating 4/5 Lumbar Intervertebral Disc Herniation |
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GUO Yue-cheng1,2
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1.（1）Dept. of Orthpaedic Surgery，Yan’an Hospital Affiliated to Kunming Medical University，Kunming Yunnan 650051;2）Dept. of Orthpaedic Surgery，People’s Hospital of Menghai County of Xishuangbanna Dai Autonomous Prefecture，Menghai Yunnan 666200，China）
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| Abstract: |
| ［Abstract］Objective To discuss the surgical strategy and clinical effect of PELD（Percutaneous endoscopic lumbar discectomy）in treatment of Lumbar intervertebral disc herniation. Methods From August to October in 2013，200 patients with L4-L5 Lumbar intervertebral disc herniation were selected to be treated by PELD. There were 124 male patients and 76 female patients. All of the patients with the average age of 41 were suffering from obvious pain in waist and lower extremities. Under local anesthesia and monitoring of radiography，and with an admission passage from shoulder and axillary region， nucleus pulposus removal was finished by the means of percutaneous endoscope. VSA（Visual Analogue Scale）and ODI（Oswestry Disability Index）were used to evaluate the clinical effect. Results The follow-up visit to 196 patients lasted for 9-24 months in which the average time was 13.5 months. The VSA of preoperative pain in waist and lower extremities was（7.5±1.8）. After operation， the VSA of the pain after 3 months was（3.0±1.5）， the VSA of the pain after 6 months was（2.8±1.3），and the VSA of the pain after 12 months was（2.0±1.5）. There were obvious differences between before operation and after operation （P＜0.01）；before operation，ODI was（58.5±17.8）%， while after operation， ODI was（29.3±10.5）% after 3 months，（20±7.5）% after 6 months，（15.6±6.4）% after 12 months. There were obvious differences between before operation and after operation（P＜0.01）. Conclusions Percutaneous endoscopic treatment of 4/5 lumbar intervertebral disc herniation from shoulder and axillary region is very complete and effective. Selecting patients correctly before operation and adequate radiology evaluation are the key to guaranteeing surgical success. |
| Key words: ［Key words］Endoscopes Minimally-invasive treatment Lumbar intervertebral disc herniation Strategy |