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[1]陳華,李紅衛(wèi),李宇衛(wèi),等.經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)中椎間孔成形的適應(yīng)證研究[J].中醫(yī)正骨,2018,30(04):8-12.
　CHEN Hua,LI Hongwei,LI Yuwei,et al.A clinical study of indications of foraminoplasty in percutaneous endoscopic lumbar discectomy[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(04):8-12.
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經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)中椎間孔成形的適應(yīng)證研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年04期
頁碼:
8-12
欄目:
腰椎疾患
出版日期:
2018-04-20

文章信息/Info

Title:
A clinical study of indications of foraminoplasty in percutaneous endoscopic lumbar discectomy
作者:
陳華; 李紅衛(wèi); 李宇衛(wèi); 沈曉峰; 陸斌杰
江蘇省蘇州市中醫(yī)醫(yī)院,江蘇 蘇州 215009
Author(s):
CHEN Hua; LI Hongwei; LI Yuwei; SHEN Xiaofeng; LU Binjie
Suzhou Hospital of Traditional Chinese Medicine,Suzhou 215009,Jiangsu,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  內(nèi)窺鏡檢查;  椎間孔;  適應(yīng)證
Keywords:
Keywords intervertebral disc displacement;  lumbar vertebrae;  endoscopy;  intervertebral foramina;  indicatio
摘要:
目的:探討經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)中椎間孔成形的適應(yīng)證。方法:選取經(jīng)椎間孔入路行經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)的單節(jié)段腰椎間盤突出癥患者,其中36例患者術(shù)中進(jìn)行了椎間孔成形(椎間孔成形組),50例患者術(shù)中未進(jìn)行椎間孔成形(椎間孔未成形組)。在患者術(shù)前的CT圖像上測定病變節(jié)段的椎間隙高度、椎間孔寬度、椎板角,在術(shù)前X線片上測定患者的髂嵴高度,在術(shù)前MRI上測定突出椎間盤的下移程度。結(jié)果:椎間孔成形組椎間隙高度低于椎間孔未成形組[(5.92±1.22)mm,(6.74±0.92)mm,t=-3.555,P=0.004],突出椎間盤向下重度移位者所占比例高于椎間孔未成形組(P=0.031); 2組患者的椎間孔寬度、椎板角及髂嵴高度比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(6.92±1.03)mm,(7.07±1.20)mm,t=-0.606,P=0.566; 99.52°±10.62°,98.23°±8.77°,t=0.616,P=0.739;(33.38±1.06)mm,(32.69±2.24)mm,t=1.713,P=0.164]。L5S1腰椎間盤突出癥患者中,椎間孔成形組的椎間隙高度、椎間孔寬度均小于椎間孔未成形組[(4.13±1.22)mm,(5.19±0.92)mm,t=-3.198,P=0.006;(5.89±1.38)mm,(7.28±1.28)mm,t=-3.387,P=0.002],髂嵴高度大于椎間孔未成形組[(35.26±3.44)mm,(32.78±2.86)mm,t=2.549,P=0.001]; 2組患者的椎板角、突出椎間盤下移程度比較,組間差異均無統(tǒng)計(jì)學(xué)意義(96.52°±8.62°,95.23°±6.77°,t=0.542,P=0.173; P=0.476)。中央型腰椎間盤突出癥患者中,椎間孔成形組的椎間隙高度小于椎間孔未成形組[(5.66±0.75)mm,(6.93±0.92)mm,t=-3.499,P=0.006],椎板角大于椎間孔未成形組(103.58°±5.32°,92.38°±4.37°,t=5.426,P=0.001); 2組患者的椎間孔寬度、髂嵴高度、突出椎間盤下移程度比較,組間差異均無統(tǒng)計(jì)學(xué)意義[(5.86±1.46)mm,(7.18±1.41)mm,t=-2.152,P=0.472;(33.25±2.01)mm,(34.03±1.63)mm,t=0.289,P=0.775; P=0.455]。結(jié)論:病變節(jié)段椎間隙狹窄的腰椎間盤突出癥、突出物向下移位嚴(yán)重的腰椎間盤突出癥、髂嵴較高的L5S1椎間盤突出癥、病變節(jié)段椎板角較大的中央型腰椎間盤突出癥,均應(yīng)視為經(jīng)皮內(nèi)窺鏡下腰椎間盤切除術(shù)中椎間孔成形的適應(yīng)證。
Abstract:
ABSTRACT Objective:To explore the indications of foraminoplasty in percutaneous endoscopic lumbar discectomy(PELD).Methods:Eighty-six patients with single-segment lumbar disc herniation(LDH)who received PELD through intervertebral foramina approach were selected.The foraminoplasty was performed on 36 patients(foraminoplasty group)and was not performed on 50 patients(non-foraminoplasty group)during the PELD.The intervertebral space height,the intervertebral foramina width and the vertebral plate angle of diseased segment were measured on patients' preoperative CT images.The iliac crest height and the downward-displacement degree of herniated intervertebral disc were measured on patients' preoperative CT images and preoperative MRI respectively.Results:The intervertebral space heights were lower,and the proportion of patients with severe downward-displacement of herniated intervertebral discs was higher in foraminoplasty group compared to non-foraminoplasty group(5.92+/-1.22 vs 6.74+/-0.92 mm,t=-3.555,P=0.004; P=0.031).There was no statistical difference in intervertebral foramina width,vertebral plate angle and iliac crest height between foraminoplasty group and non-foraminoplasty group(6.92+/-1.03 vs 7.07+/-1.20 mm,t=-0.606,P=0.566; 99.52+/-10.62 vs 98.23+/-8.77 degrees,t=0.616,P=0.739; 33.38+/-1.06 vs 32.69+/-2.24 mm,t=1.713,P=0.164).For patients with L5-S1 LDH,the intervertebral space heights and the intervertebral foramina widths were smaller and the iliac crest heights were greater in foraminoplasty group compared to non-foraminoplasty group(4.13+/-1.22 vs 5.19+/-0.92 mm,t=-3.198,P=0.006; 5.89+/-1.38 vs 7.28+/-1.28 mm, t=-3.387,P=0.002; 35.26+/-3.44 vs 32.78+/-2.86 mm,t=2.549,P=0.001),while there was no statistical difference in vertebral plate angle and downward-displacement degree of herniated intervertebral discs between foraminoplasty group and non-foraminoplasty group(96.52+/-8.62 vs 95.23+/-6.77 degrees,t=0.542,P=0.173; P=0.476).For patients with central-type LDH,the intervertebral space heights were smaller and the vertebral plate angles were larger in foraminoplasty group compared to non-foraminoplasty group(5.66+/-0.75 vs 6.93+/-0.92 mm,t=-3.499,P=0.006; 103.58+/-5.32 vs 92.38+/-4.37 degrees,t=5.426,P=0.001),while there was no statistical difference in intervertebral foramina width,iliac crest height and downward-displacement degree of herniated intervertebral discs between foraminoplasty group and non-foraminoplasty group(5.86+/-1.46 vs 7.18+/-1.41 mm,t=-2.152,P=0.472; 33.25+/-2.01 vs 34.03+/-1.63 mm,t=0.289,P=0.775; P=0.455).Conclusion:LDH with narrow intervertebral space at diseased segment,LDH with severe downward displacement of herniated disc,L5-S1 LDH with high iliac crest and central-type LDH with large vertebral plate angle at diseased segment should be regarded as the indications of foraminoplasty in PELD.

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備注/Memo

備注/Memo:
基金項(xiàng)目:江蘇省蘇州市臨床重點(diǎn)病種診療技術(shù)專項(xiàng)項(xiàng)目(LCZX201513) 通訊作者:李紅衛(wèi) E-mail:[email protected]
更新日期/Last Update: 2018-08-24