侧后路椎间孔镜手术相关并发症及预防措施

摘要

目的 探讨侧后路经皮穿刺椎间孔镜辅助下髓核摘除、椎管减压、椎间孔成形、射频消融术治疗腰椎间盘突出症的相关并发症及预防措施.方法 回顾性统计分析我院568例椎间孔镜手术相关并发症、可能原因、预防及处理方法.结果 568例椎间孔镜手术共出现并发症24例,总体发生率4.23％,其中硬脊膜损伤4例(0.70％),椎管内静脉丛损伤出血3例(0.53％),术后伤口疼痛6例(1.06％),术后复发8例(1.41％),术后症状缓解不明显1例(0.18％),出口神经根支配区感觉异常2例(0.35％).结论 椎间孔镜手术安全、有效,并发症发生率低,但学习曲线较陡峭,并发症的发生与手术适应证的把握、操作的熟练程度和解剖变异有关,可以通过有效的预防措施而降低并发症发生率.%Objective To analyze the occurrence of the complications after percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation or stenosis,and to reveal the effective prevention methods.Methods Retrospectively analyzed the clinical data of 568 cases who undertaken PELD,and all the related complications,possible causes,prevention and treatment methods were analyzed.Results There were 24 cases of complications occured in all the 568 cases treated with PELD,and the gross incidence rate was 4.23％,including 4 cases of dural laceration(0.70％),3 cases of hemorrhage of intravertebral vein plexus injury(0.53％),6 cases of postoperative wound pain (1.06％),8 cases of postoperative recurrence (1.41％),1 case with persistent symptoms after surgery (0.18％),2 cases of postoperative paresthesia(0.35％).Conclusion PELD is a minimally invasive surgery with high security and low incidence of complications.The effective preventions including careful decision-making,elaborate operation,and precise identification of the anatomical abnormality.