中国修复重建外科杂志

中国修复重建外科杂志

经皮脊柱内窥镜治疗以臀部疼痛为主的腰椎间盘突出症近期疗效分析

查看全文

目的探讨经皮脊柱内窥镜治疗以臀部疼痛为主的腰椎间盘突出症的近期疗效。方法2015 年 6 月–2016 年 5 月,采用经皮脊柱内窥镜治疗以臀部疼痛为主的腰椎间盘突出症患者 36 例。男 26 例,女 10 例;年龄 18~76 岁,平均 35.6 岁。病程 3 个月~10 年,平均 14 个月。单纯臀部疼痛 2 例,臀部疼痛伴大腿疼痛 6 例,伴同侧下肢疼痛 28 例。单节段椎间盘突出 34 例(L45 15 例,L5、S1 19 例),L45 合并 L5、S1 2 例。术前臀部疼痛视觉模拟评分(VAS)为(6.1±1.3)分。术后 1、3、6 个月及末次随访时采用 VAS 评分评价臀部疼痛程度,末次随访时采用改良 MacNab 标准评价临床疗效。结果所有患者手术均顺利完成,手术时间 27~91 min,平均 51 min。术中无神经根损伤、硬膜囊撕裂及椎管内血肿形成等并发症发生。住院时间为 3~8 d,平均 5.3 d。术后切口愈合良好,无感染发生。36 例均获随访,随访时间 12~24 个月,中位时间 16 个月。术后 3 个月腰椎 MRI 检查示手术节段神经根和硬膜囊无明显压迫。术后 1、3、6 个月及末次随访时臀部 VAS 评分分别为(1.1±0.6)、(0.9±0.3)、(1.0±0.3)、(0.9±0.4)分,均较术前显著改善(P<0.05);术后各时间点间比较差异无统计学意义(P>0.05)。末次随访时根据改良 MacNab 标准评价疗效,优 27 例、良 7 例、可 2 例,优良率 94.4%。结论采用经皮脊柱内窥镜治疗以臀部疼痛为主的腰椎间盘突出症安全、创伤小,可获得良好近期疗效。

ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.

关键词: 腰椎间盘突出症; 臀部疼痛; 经皮脊柱内窥镜技术; 微创技术

Key words: Lumbar disc herniation; buttock pain; percutaneous endoscopic lumbar discectomy; minimally invasive technique

引用本文: 蔡鹏, 孔清泉, 宋跃明. 经皮脊柱内窥镜治疗以臀部疼痛为主的腰椎间盘突出症近期疗效分析. 中国修复重建外科杂志, 2018, 32(6): 673-677. doi: 10.7507/1002-1892.201712015 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Takahashi N, Yabuki S, Aoki Y, et al. Pathomechanisms of nerve root injury caused by disc herniation: an experimental study of mechanical compression and chemical irritation. Spine (Phila Pa 1976), 2003, 28(5): 435-441.
2. Kuslich SD, Ulstrom CL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am, 1991, 22(2): 181-187.
3. Kim DS, Lee JK, Jang JW, et al. Clinical features and treatments of upper lumbar disc herniations. J Korean Neurosurg S, 2010, 48(2): 119-124.
4. Wouda EJ, Leenstra S, Vanneste JA. Scrotal pain as the presenting symptom of lumbar disc herniation: a report of 2 cases. Spine (Phila Pa 1976), 2005, 30(2): E47-49.
5. 贺学军, 易惠军, 范友兵, 等. 以腰臀部疼痛为主的腰椎间盘突出症. 颈腰痛杂志, 2010, 31(5): 327-329.
6. 曹家树, 刘乐, 易志坚, 等. 腰椎间盘突出症与下腹痛的关系4例分析. 中国矫形外科杂志, 2010, 18(17): 1496.
7. Yukawa Y, Kato F, Kajino G, et al. Groin pain associated with lower lumbar disc herniation. Spine (Phila Pa 1976), 1997, 22(15): 1736-1740.
8. Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 931-939.
9. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
10. Bartynski WS. Clinical, anatomic, and imaging correlation in spine-related pain: the essential elements. Tech Vasc Interv Radiol, 2009, 12(1): 2-10.
11. 王洪伟, 李长青, 周跃. 腰椎间盘突出症疼痛发生机制的研究进展. 中国矫形外科杂志, 2011, 19(7): 568-571.
12. Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int, 2008, 105(12): 214-219.
13. McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med, 2012, 27(4): 261-274.
14. 胡建山, 施向春, 王开明. 腰椎间盘突出症与臀肌张力减退诊断体征. 中国骨伤, 2001, 14(6): 361-362.
15. 桑锡光, 汤继文, 陈允震. 以臀部症状为主的腰椎间盘突出症 15 例临床分析. 山东医药, 2003, 43(32): 40-41.
16. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976), 1983, 8(3): 286-293.
17. Konno T, Aota Y, Kuniya H, et al. Anatomical etiology of "pseudo-sciatica" from superior cluneal nerve entrapment: a laboratory investigation. J Pain Res, 2017, 10: 2539-2545.
18. Nakamura SI, Takahashi K, Takahashi Y, et al. The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration. J Bone Joint Surg (Br), 1996, 78(4): 606-612.
19. Suseki K, Takahashi Y, Takahashi K, et al. Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain. J Bone Joint Surg (Br), 1998, 80(4): 737-742.
20. 石作为, 姚猛, 王岩松, 等. 间盘源性下腰痛发生机制的探讨. 中国疼痛医学杂志, 2007, 13(1): 32-35.
21. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain, 2009, 147(1-3): 17-19.
22. 王刚, 刘尚礼, 程志安, 等. 椎间盘切除术对腰椎间盘突出症腰痛的影响. 中国矫形外科杂志, 2009, 17(1): 23-26.
23. Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976), 2007, 32(16): 1735-1747.
24. 王建, 周跃, 李长青, 等. 经皮内镜椎间盘切除术治疗慢性椎间盘源性腰痛的初步研究. 中国修复重建外科杂志, 2009, 23(4): 400-403.
25. Tsou PM, Alan YC, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J, 2004, 4(5): 564-573.
26. Ahn Y, Lee SH. Outcome predictors of percutaneous endoscopic lumbar discectomy and thermal annuloplasty for discogenic low back pain. Acta Neurochir (Wien), 2010, 152(10): 1695-1702.