Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation.
Percutaneous Endoscopic Interlaminar Discectomy with Modified Sensation-Motion Separation Anesthesia for Beginning Surgeons in the Treatment of L5-S1 Disc Herniation.
复制标题
经皮内窥镜椎间盘切除术联合改良感觉-运动分离麻醉，为新手外科医生治疗 L5-S1 椎间盘突出症
DOI：
10.2147/jpr.s306319
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发表时间：
2021
影响因子：
2.7
通讯作者：
Ma X
中科院分区：
文献类型：
--
作者：
Kong M;Gao C;Cong W;Li G;Zhou C;Ma X
目的比较局麻(LA)、全麻(GA)和改良式感觉-运动分离麻醉(MA)在经皮内窥镜腰椎板间摘除术(PEID)治疗L5/S1腰椎间盘突出症(LDH)中的临床效果，以指导年轻外科医生。方法84例L5/S1腰椎间盘突出症患者，采用三种麻醉方法行PEID手术。LA组(26例)、GA组(29例)和MA组(29例)患者接受了回顾性的随访检查。比较两组患者的一般参数、麻醉准备时间、手术时间、恢复时间、并发症发生率、下地活动时间、住院时间、严重并发症发生率和再手术率，并采用视觉模拟评分(VAS)、OSwestry残疾指数(ODI)和简明健康调查36(SF-36)对临床结果进行分析。结果MA在手术时间上明显优于其他两种方法，术中体验优于LA。MA组患者术后卧床时间和住院时间均少于GA组。各组术后VAS、ODI和SF-36评分均明显好于术前(P<；0.05)，但三组间差异无统计学意义(P>；0.05)。GA组有3例(3/29)出现神经功能障碍。2例患者(GA组1例(1/29)，LA组1例(1/26))行翻修手术，总复发率为2.4%(2/84)。结论MA安全性高，患者耐受性好，适合于无PEID经验的脊柱外科医生治疗L5/S1腰椎间盘突出症。
Purpose To compare the clinical effects of local anesthesia (LA), general anesthesia (GA) and modified sensation-motion separation anesthesia (MA) in percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of L5/S1 lumbar disc herniation (LDH) for the purpose of guiding junior surgeons. Methods Eighty-four patients with L5/S1 LDH underwent PEID using three anesthesia methods. Patients in the LA (26), GA (29) and MA (29) groups received a follow-up examination retrospectively. The general parameters, preparation and anesthesia duration, operative duration, recovery time, incidence of complications, ambulation time, length of hospital stay, incidence of severe complications, and reoperation rate were compared, and clinical outcomes were analyzed using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form Health Survey 36 (SF-36). Results MA demonstrated obvious advantages over the other two methods with respect to operative duration and resulted in a better intraoperative experience than LA. The patients in the MA group required less time in bed postoperatively and shorter hospital stays than those in the GA group. The mean postoperative VAS, ODI and SF-36 scores were significantly better than the preoperative scores in all groups (P<0.05), but no significant differences in these scores were found among the three groups (P>0.05). Three cases (3/29) of nervous disorder occurred in the GA group. Two patients (one in the GA group (1/29) and one in the LA (1/26) group) underwent revision surgery, with a total recurrence rate of 2.4% (2/84). Conclusion Due to its high safety and good tolerance by patients, MA is a suitable method for spinal surgeons who are inexperienced with PEID in the treatment of L5/S1 disc herniation.