84年鼠女哪年财运最旺,857comvvv色九欧美激情|85PO_87国产精品欲av国产av资源

[1]李毅力,王申,白玉,等.應(yīng)用可視化椎弓根有限切除技術(shù)行經(jīng)皮椎間孔入路內(nèi)鏡下椎間盤切除術(shù)治療高度游離型腰椎間盤突出癥[J].中醫(yī)正骨,2023,35(03):68-72.
點(diǎn)擊復(fù)制

應(yīng)用可視化椎弓根有限切除技術(shù)行經(jīng)皮椎間孔入路內(nèi)鏡下椎間盤切除術(shù)治療高度游離型腰椎間盤突出癥()
分享到:

《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年03期
頁碼:
68-72
欄目:
臨床報(bào)道
出版日期:
2023-03-20

文章信息/Info

作者:
李毅力1王申2白玉1代耀軍1孫宜保1楊勇1
(1.鄭州市骨科醫(yī)院,河南 鄭州 450052; 2.淅川縣中醫(yī)院,河南 淅川 474450)
關(guān)鍵詞:
腰椎 椎間盤移位 椎間盤切除術(shù) 內(nèi)窺鏡檢查 椎弓根有限切除
摘要:
目的:觀察應(yīng)用可視化椎弓根有限切除技術(shù)行經(jīng)皮椎間孔入路內(nèi)鏡下椎間盤切除術(shù)(percutaneous endoscopic transforaminal discectomy,PETD)治療高度游離型腰椎間盤突出癥(high-migrated lumbar disc herniation,HM-LDH)的臨床療效和安全性。方法:2018年1月至2019年1月,應(yīng)用可視化椎弓根有限切除技術(shù)行PETD治療HM-LDH患者68例。男39例,女29例。年齡24~59歲,中位數(shù)47歲。均為單節(jié)段椎間盤突出,其中L3~4 8例、L4~5 48例、L5S1 12例。突出的髓核組織向上游離41例,向下游離27例。記錄手術(shù)時(shí)間、術(shù)中X線透視次數(shù); 于術(shù)前和術(shù)后1個(gè)月、3個(gè)月、6個(gè)月、12個(gè)月及末次隨訪時(shí),采用視覺模擬量表(visual analogue scale,VAS)評(píng)價(jià)腿部疼痛程度,采用Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)評(píng)價(jià)腰部功能; 于術(shù)前和末次隨訪時(shí)采用簡明健康狀況調(diào)查表(short form 36 health survey questionnaire,SF-36)評(píng)估患者生活質(zhì)量; 末次隨訪時(shí),采用MacNab評(píng)定標(biāo)準(zhǔn)評(píng)價(jià)綜合療效; 隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:本組68例患者均順利完成手術(shù)。手術(shù)時(shí)間(47.5±15.3)min。術(shù)中X線透視(3.13±1.56)次。所有患者均獲隨訪,隨訪時(shí)間為29~41個(gè)月,中位數(shù)36個(gè)月。患者不同時(shí)間點(diǎn)腿部疼痛VAS評(píng)分和ODI均呈下降趨勢(shì)[(6.06±1.20)分,(1.21±0.77)分,(1.01±0.59)分,(0.96±0.66)分,(0.93±0.65)分,(0.85±0.72)分,F=469.153,P=0.000;(54.65±12.55)%,(30.13±7.77)%,(23.63±6.28)%,(20.69±5.93)%,(19.24±5.53)%,(19.01±4.83)%,F=222.609,P=0.000]; 末次隨訪時(shí),患者SF-36評(píng)分高于術(shù)前[(33.27±13.23)分,(66.81±12.35)分,t=-12.276,P=0.000],綜合療效優(yōu)51例、良14例、可3例。2例患者術(shù)后第1天出現(xiàn)小腿后外側(cè)麻木,均未發(fā)生神經(jīng)根損傷、類脊髓高壓綜合征、感染、椎管內(nèi)血腫等并發(fā)癥。結(jié)論:應(yīng)用可視化椎弓根有限切除技術(shù)行PETD治療HM-LDH,手術(shù)時(shí)間短,術(shù)中X線透視次數(shù)少,能夠緩解患者腿部疼痛、改善腰部功能、提高生活質(zhì)量,且安全性高。

參考文獻(xiàn)/References:

[1] 王想福,葉丙霖,孫鳳歧,等.經(jīng)皮內(nèi)鏡椎弓根錨定技術(shù)治療高度游離型腰椎間盤突出癥[J].中國骨傷,2020,33(6):514-518.
[2] 馬術(shù)友,李振宙,曹崢,等.經(jīng)皮椎弓峽部椎間孔成形全內(nèi)鏡下腰椎間盤摘除術(shù)治療頭側(cè)超高度移位型腰椎間盤突出癥[J].中國骨與關(guān)節(jié)雜志,2020,9(6):450-456.
[3] HUANG K L,CHEN G L,LU S,et al.Early clinical outcomes of percutaneous endoscopic lumbar discectomy for L4-5 highly down-migrated disc herniation:interlaminar approach versus transforaminal approach[J].World neurosurgery,2021,146:e413-e418.
[4] 李玉偉,王海蛟,王義生,等.PTED與TLIF治療高位腰椎間盤突出癥的效果比較[J].中華醫(yī)學(xué)雜志,2018,98(2):113-116.
[5] 徐彬,徐峰,李濤,等.經(jīng)皮椎間孔鏡技術(shù)治療脫出游離型腰椎間盤突出癥的臨床研究[J].中國矯形外科雜志,2018,26(9):769-774.
[6] 尹亞娜,李毅斌,諶祖江,等.非手術(shù)治療腰椎間盤突出癥療效評(píng)價(jià)方法的研究進(jìn)展[J].中醫(yī)正骨,2022,34(1):69-72.
[7] LIU C,CHU L,YONG H C,et al.Percutaneous endoscopic lumbar discectomy for highly migrated lumbar disc herniation[J].Pain Physician,2017,20(1):E75-E84.
[8] 劉紅光,吳小濤,黃愛,等.經(jīng)皮內(nèi)鏡下腰椎間盤切除術(shù)治療脫出游離型腰椎間盤突出癥的療效分析[J].頸腰痛雜志,2019,40(6):834-836.
[9] 淦科,葉蜀新,林海,等.經(jīng)皮椎間孔鏡下TESSYS技術(shù)治療游離型腰椎間盤突出癥[J].臨床骨科雜志,2019,22(1):39-41.
[10] 蔣協(xié)遠(yuǎn),王大偉.骨科臨床療效評(píng)價(jià)標(biāo)準(zhǔn)[M].北京:人民衛(wèi)生出版社,2005:119-121
[11] KARIMI M,ZAHEDNEJAD S,NEGAHBAN H,et al.Vali-dity and reliability of the Persian version of the STarT musculoskeletal tool[J].Physiotherapy theory and practice,2022:1-9.
[12] 陳仲強(qiáng).脊柱外科學(xué)[M].北京:人民衛(wèi)生出版社,2013:441-442.
[13] KUZEYLI K,CAKIR E,USUL H,et al.Posterior epidural migration of lumbar disc fragments:report of three cases[J].Spine(Phila Pa 1976),2003,28(3):E64-E67.
[14] CHUL W L,KANG J Y,SANG S H,et al.Foraminoplastic superior vertebral notch approach with reamers in percutaneous endoscopic lumbar discectomy:technical note and clinical outcome in limited indications of percutaneous endoscopic lumbar disceetomy[J].J Korean Neurosurg Soc,2016,59(2):172-181.
[15] LIN G X,PARK C W,SUEN T K,et al.Full endoscopic technique for high-grade up-migrated lumbar disk herniation via a translaminar keyhole approach:preliminary series and technical note[J]. J Neurol Surg A Cent Eur Neurosurg,2020,81(5): 379-386.
[16] 王建華,程翰林,黃順?biāo)?等.兩種內(nèi)鏡手術(shù)治療脫出游離型腰椎間盤突出癥的近期療效比較[J].頸腰痛雜志,2020,41(1):71-74.
[17] 陳盼,鄭丹楊,丁偉國,等.單邊雙通道內(nèi)鏡下椎間盤切除術(shù)治療高度游離型腰椎間盤突出癥[J].中國修復(fù)與重建外科雜志,2022,36(7):860-865.
[18] AHN Y,JANG I T,KIM W K.Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation[J].Clin Neurol Neurosurg,2016,147:11-17.
[19] HUANG M K,CHEN M G,SHENG L M,et al.Early clinical outcomes of percutaneous endoscopic lumbar discectomy for L4-5 highly down-migrated disc herniation:interlaminar approach versus transforaminal approach[J].World Neurosurgery,2020,146:e413-e418.
[20] YEUNG A T,TSOU P M.Posterolateral endoscopic excision for lumbar disc herniation:Surgical technique,outcome,and complications in 307 consecutive cases[J].Spine,2002,27(7):722-731.
[21] 肖清清,李越,吳忌,等.椎間孔前上象限成形入路治療高度向上游離腰椎間盤突出癥[J].中國微創(chuàng)外科雜志,2021,21(4):328-332.
[22] DEZAWA A,MIKAMI H,SAIRYO K.Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine[J].Asian J Endosc Surg,2012,5(4):200-203.
[23] XIN Z J,LIAO W B,AO J,et al.A modified translaminar osseous channel-assisted percutaneous endoscopic lumbar discectomy for highly migrated and sequestrated disc herniations of the upper lumbar:clinical outcomes,surgical indications,and technical considerations[J].Biomed Research International,2017,2017:3069575.
[24] 林海,張世民,吳冠男,等.兩種不同入路椎間孔鏡技術(shù)治療L4,5椎間盤突出癥[J].中國骨傷,2019,32(10):904-909.
[25] 李振宙,侯樹勛,宋科冉,等.經(jīng)椎板間隙入路完全內(nèi)窺鏡下椎間盤摘除術(shù)治療L5/S1非包含型椎間盤突出癥[J].中國脊柱脊髓雜志,2013,23(9):771-777.
[26] 宋飛霏,劉磊,馬超,等.經(jīng)皮椎間孔鏡手術(shù)治療游離脫垂型腰椎間盤突出癥的療效觀察[J].中國骨與關(guān)節(jié)損傷雜志,2019,34(9):962-964.
[27] CHOI K C,LEE D C,SHIM H K.et al.A strategy of percutaneous endoscopic lumbar discectomy for migrated disc herniation[J].World neurosurgery,2017,99:259-266.

相似文獻(xiàn)/References:

[1]吳青坡,孫國紹,王林杰.后路椎管減壓聯(lián)合腰椎椎弓根釘動(dòng)態(tài)穩(wěn)定裝置內(nèi)固定 治療單節(jié)段腰椎退行性疾病[J].中醫(yī)正骨,2015,27(10):42.
[2]李林軍.應(yīng)用膨脹式椎弓根螺釘內(nèi)固定治療合并骨質(zhì)疏松的 胸腰椎退行性疾病[J].中醫(yī)正骨,2015,27(08):49.
[3]孫廣江,崔海艦.絡(luò)病理論指導(dǎo)下應(yīng)用獨(dú)活寄生湯加減治療腰椎間盤突出癥[J].中醫(yī)正骨,2015,27(12):37.
 SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(獨(dú)活寄生湯加減)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(03):37.
[4]陳冠軍,陳揚(yáng),莊汝杰.可灌注骨水泥椎弓根螺釘系統(tǒng) 在老年腰椎疾患手術(shù)中的應(yīng)用[J].中醫(yī)正骨,2015,27(02):40.
[5]萬宏波,馬海燕,蔣云霞,等.口服益氣化瘀湯聯(lián)合功能鍛煉治療腰椎退行性疾病 術(shù)后殘留腰腿痛的臨床研究[J].中醫(yī)正骨,2015,27(06):1.
 WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益氣化瘀湯)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(03):1.
[6]王世龍.腰椎椎管內(nèi)外痛風(fēng)石1例[J].中醫(yī)正骨,2012,24(02):69.
[7]秦杰,李振宇.三法十式手法配合中藥腰痹湯治療腰椎間盤突出癥[J].中醫(yī)正骨,2011,23(02):71.
[8]顏 峰.椎間融合術(shù)配合中藥外敷治療退行性腰椎滑脫癥[J].中醫(yī)正骨,2016,28(01):38.
[9]喻秋萍,唐萌芽,王崢峰,等.身痛逐瘀湯治療腰椎間盤突出癥的系統(tǒng)評(píng)價(jià)[J].中醫(yī)正骨,2016,28(06):24.
 YU Qiuping,TANG Mengya,WANG Zhengfeng,et al.Efficacy of Shentong Zhuyu Tang(身痛逐瘀湯)for treatment of lumbar disc herniation:a systematic review[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(03):24.
[10]董永強(qiáng),何鑫東,張偉偉,等.經(jīng)皮椎間孔鏡髓核摘除術(shù)聯(lián)合McKenzie療法治療腰椎間盤突出癥的臨床研究[J].中醫(yī)正骨,2016,28(07):38.
 DONG Yongqiang,HE Xindong,ZHANG Weiwei,et al.Observation on the curative effect of fire-needle therapy for treatment of supraspinal and interspinal ligament injuries[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(03):38.
[11]劉彥璐,林耐球,李紹旦,等.正骨手法結(jié)合中藥外敷治療腰椎間盤突出癥[J].中醫(yī)正骨,2015,27(02):26.
[12]邵禮暉,潘浩.Coflex棘突間動(dòng)態(tài)穩(wěn)定系統(tǒng)治療腰椎退變性疾病40例[J].中醫(yī)正骨,2015,27(02):37.
[13]郭新軍,朱卉敏,王衡,等.一次性纖維環(huán)縫合器在腰椎間盤突出癥髓核摘除術(shù)中的應(yīng)用[J].中醫(yī)正骨,2015,27(03):59.
[14]林斌,黎秋生,何勇,等.椎弓根螺釘單側(cè)固定與雙側(cè)固定治療腰椎間盤突出癥 對(duì)鄰近節(jié)段退變的影響[J].中醫(yī)正骨,2015,27(01):16.
 LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(03):16.
[15]賈龍,張華.“治未病”思想指導(dǎo)下腰椎間盤突出癥的辨證防治[J].中醫(yī)正骨,2017,29(01):36.
[16]聶富祥,賀海懌,朱文輝,等.一次性可擴(kuò)張通道下微創(chuàng)經(jīng)椎間孔入路腰椎間融合術(shù)治療單節(jié)段腰椎退行性疾病[J].中醫(yī)正骨,2017,29(05):34.
[17]宋仁謙,周英杰,趙剛.經(jīng)皮可灌注骨水泥椎弓根螺釘固定治療合并嚴(yán)重骨質(zhì)疏松癥的腰椎退行性疾病[J].中醫(yī)正骨,2017,29(05):37.
[18]張史飛,任紹東,屠永剛,等.椎弓根螺釘雙皮質(zhì)固定治療合并骨質(zhì)疏松的腰椎不穩(wěn)癥[J].中醫(yī)正骨,2017,29(09):73.
[19]鄧羅義,孫紅,寧旭.神經(jīng)根沉降征及其在腰椎退行性疾病診斷中的應(yīng)用價(jià)值[J].中醫(yī)正骨,2018,30(08):50.
[20]李智斐,李嘉瑯,張翼升,等.醫(yī)用臭氧治療腰椎間盤突出癥的作用機(jī)制及應(yīng)用進(jìn)展[J].中醫(yī)正骨,2018,30(10):59.

備注/Memo

備注/Memo:
基金項(xiàng)目:河南省醫(yī)學(xué)適宜技術(shù)推廣項(xiàng)目(SYJS2020152)
通訊作者:楊勇 E-mail:[email protected]
更新日期/Last Update: 1900-01-01