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椎间孔镜与传统手术PPT
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.
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