椎间孔镜与传统手术PPT.pptx

椎间孔镜手术与传统显微手术比较的文献复习北京医院神经外科 王作伟椎间孔镜治疗腰椎间盘突出症The median overall improvement of leg pain(VAS) was 88 %(range 65–89%), global perceived effect(MacNab) 85% (72–94%), return to work 90%, recurrencerate 5.7%, complications 2.8%, re-operations 7%.不同部位疼痛的缓解ttransforaminal endoscopic surgery compared to open microdiscectomy椎间孔镜与显微手术的比较transforamina endoscopic surgeryopen laminotomy effectiveness GPE (MacNab/other) 84% (70–97%) 78% (65–93%) Recurrences5.7% (5–6.6%) 2.9% (0–6.8%)Complications1.5% (0–6.7%) 1.0% (0–12%) Re-operations 6.8% (3.3–15%) 4.7 %(0–11.5%)advantageless tissue injuryshorter operating timesless blood loss (even if not statistically evaluated)less postoperative surgical site painshorter hospital stayfaster return to workeconomic advantage ?disadvantagesteep learning curveradiation exposureRecurrences ?Transforaminal endoscopic spinal surgery： The future ‘gold standard’ for discectomy?椎间孔镜手术： 也许是未来椎间盘切除手术的“金标准”谢谢！The MacNab score is a 4-point scale ranging from 1 (excellent); 2 (good), 3 (fair) to 4 (poor). In most studies‘excellent’ and ‘good’ were combined and labelled ‘satisfactory’.we defined a recurrence as a re-appearance of a symptomatic lumbar disc herniation at the same level after a pain-free interval of longer than a month.As in most surgical interventions, adequate patient selection and accurate diagnosis seem very important. Most common cause for re-operations was persistent complaints due to missed lateral bony stenosis and remnant fragmentsTransforaminal endoscopic surgery has a steep learning curve that requires patience and experience，Most reported complications were transient dysaesthesia or hypaesthesia.In East Asia up to 30% of all spinal surgery is now performed by endoscopic techniques.