脊柱内镜下经椎板间入路腰椎间盘切除术的并发症及防治策略分析

Percutaneous endoscopic interlaminar discectomy: the complications and their interventions

摘要:

摘要：目的??分析脊柱内镜下经椎板间入路腰椎间盘切除术（PEID）治疗腰椎间盘突出症的手术并发症，并探讨其防治策略。方法 回顾性分析深圳市第六人民医院2016年3月－2017年6月收治的腰椎间盘突出症患者360例。其中，男216例，女144例；年龄24～68岁，平均（43.57±7.63）岁。均在全麻及C型臂X线机监视下行PEID。观察术中和术后并发症及其处理方法。结果 手术时间30～90?min，平均（52.30±16.80）min。术后随访24个月。最后一次随访时，VAS评分（2.62±0.81）分较术前（7.43±1.95）分明显降低（t?=?4.69，P?=?0.017），改良MacNab评分结果显示优良率为94.17%。出现并发症19例，发生率为5.28%，其中神经根纤维束部分损伤1例，髓核部分残留3例，脑脊液渗漏1例，2例术后椎间隙感染，11例患者术后出现感觉异常，经对症处理后，恢复正常。随访24个月后，有6例患者复发，其中4例接受椎间盘镜（MED）治疗，2例接受了微创经椎间孔入路椎间融合术（MIS-TLIF）治疗。结论 PEID的并发症并不少见，应严格掌握手术适应证，提高手术操作技能，并做好相应的应对措施。

Abstract:

Abstract: Objectives?To analyze the complications in percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation, and to investigate their interventions.?Methods?360 patients with lumbar disc hemiation from March 2016 to June 2017 were retrospectively analyzed, including 216 males and 144 females with an average of (43.57?±?7.63) years (24?~?68 years). After general anesthesia. PEID was performed assisted by C-arm monitoring. The complications during operation and after operation were studied retrospectively.?Results?The operation time ranged from 30?~?90 minutes, with an average of (52.30?±?16.80) minutes. The follow-up period was 24 months. At the last follow-up, the VAS score (2.62?±?0.81) was significantly lower than that before operation (7.43?±?1.95) (t?=?4.69, P?=?0.017). The modified MacNab score showed that the excellent and good rate was 94.17%. The incidence of complications in this study was 5.28%. Among them, 1 case had partial nerve root tract injury, 3 cases had residual nucleus pulposus, 1 case had cerebrospinal fluid leakage. 2 cases had intervertebral space infection, 11 cases had sensory abnormalities after operation, and recovered to normal after symptomatic treatment. After 24 months of follow-up, 6 cases had recurrence, of which 4 cases were treated with MED and 2 cases with minimally invasive lumbar fusion MIS-TLIF treatment.?Conclusion?The complications of PEID are not uncommon. It is necessary to strictly grasp the indications, improve the surgical skills and take appropriate measures.