| 徐国康,苏棋,屠玉兰.经皮椎间孔镜结合镜下磨钻技术治疗复杂退变性腰椎间盘突出症[J].浙江中西医结合杂志,2019,29(10): |
| 经皮椎间孔镜结合镜下磨钻技术治疗复杂退变性腰椎间盘突出症 |
| The study of TESSYS technique combined with endoscopic milling drill for the treatment of complex degenerative lumbar disc herniation |
| 投稿时间：2018-12-29 修订日期：2019-09-11 |
| DOI： |
| 中文关键词: 椎间孔镜 腰椎间盘突出症 椎管狭窄 减压 微创 |
| 英文关键词:percutaneous transforaminal endoscopy lumbar disc herniation spinal stenosis decompression minimally invasive. |
| 基金项目:杭州市科技局引导项目 |
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| 中文摘要: |
| 摘 要 目的： 探讨经皮椎间孔镜（TESSYS）结合镜下磨钻技术治疗复杂退变性腰椎间盘突出症的临床有效性和安全性。方法： 2016年10月～2018年03月，采用TESSYS结合镜下磨钻技术治疗80例复杂性腰椎间盘突出症患者，其中男40例，女40例，平均年龄63.911.2岁（50～92岁）。记录手术时间、透视次数、术中出血量、术中术后并发症情况；记录术前、术后 1天、术后3天、术后3周、术后6周、术后12周六个时间点的腿痛、腰痛视觉模拟评分（visual analogue scale，VAS）及术前、术后6周与12周的Oswsetry功能障碍指数（Oswestry disability index，ODI），统计分析比较术前与术后各时间点的差异。结果： 80例患者均顺利完成手术，手术时间40～159min，平均82.721.7min。术中透视12～57次，平均31.312.7次。术中出血5～460ml，平均26.99.3ml。术中发生并发症14例：包括颈后痛3例；神经根损伤2例；硬膜损伤3例；术中损伤血管致出血大于250ml 2例；器械折断2例；导针移位超过一个椎体距离2例，术中并发症发生率17.5%（14/80）。住院天数3～11d，平均5.51.2d。医疗费用1.3～1.9万元 ，平均1.50.2万元。80例患者均获得随访，随访时间6.2±1.6个月（3～18个月）。术后五个时间点腰腿痛VAS 评分及术后两个时间点ODI指数评分与术前相比较差异均有统计学意义（P＜0.01）。结论：TESSYS 技术结合镜下磨钻治疗复杂退变性腰椎间盘突出症能实现对神经根周围充分彻底减压，疗效满意，是一种安全、有效的微创术式。 |
| 英文摘要: |
| Abstract：Objectives：To investigate the operative safety and efficacy of TESSYS technique combined with endoscopic milling drill for the treatment of complex degenerative lumbar disc herniation. Methods: From October 2016 to March 2018, 80 patients (40 males and 40 females) with complex degenerative lumbar disc herniation were performed TESSYS technique decompression. The age of patients ranged from 50 years to 92 years with an average of 63.911.2 years. Operation time, X-ray radiation times, intraoperative blood loss, operative complications were recorded; the leg and back pain VAS scores were recorded preoperatively and at 1 day, 3 days, 3 weeks, 6 weeks and 12 weeks after operation; moreover, the ODI scores were recorded preoperatively, at 6 weeks and 12 weeks after operation. Statistical analysis was performed. Results: All 80 patients were successfully operated. The average operation time was 82.721.7min (range, 40-159 minutes), the average X-ray radiation times were 31.312.7 times (range, 12-57 times) , the average intraoperative blood loss was 26.99.3ml (range, 5-460 ml). There are various complications happened in 14 patients, including: neck pain in 3; nerve root injury in 2; dural tearing in 3; more than 250ml of blood loss during operation in 2; operative instruments breakages in 2; the guide needle moving over a vertebral body in 2, the total incidence rate of complications was 17.5% (14/80). The mean hospital days was 5.51.2d (range, 3-11days), and the mean medical expenses was 152.0 thousands RMB (range,13-19thousands RMB). All patients were received follow-up from 3 to 18 months with an average of 6.2±1.6 months．There were significant differences in both VAS scores and ODI scores at each postoperative follow-up time point when compared with the preoperative scores(P<0.01). Conclusions: TESSYS technique combined with milling drill has the capable of achieving adequate and thorough decompression around the nerve root for the treatment of complex degenerative lumbar disc herniation, which is a safe, effective, minimally invasive surgical technology and has a satisfying curative effect. |
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