英语晨读 ·
山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。
本次文献选自Pan M , Li Q , Li S , et al. Percutaneous Endoscopic Lumbar Discectomy: Indications and Complications[J]. Pain physician, 2020, 23(1):49-56.本次学习由赵学军主任医师主讲。
Lumbar Vertebral Metastasis
Advanced malignant tumors including breast cancer, lung cancer, renal cell carcinoma, and prostate cancer may invade vertebrae, and then cause intractable pain and pathological vertebral fracture. Spinal canal encroachment also leads to compression of the spinal cord and nerve root. Considering the severity of advanced malignant tumors, the purpose of treatment often consists of relieving symptoms and improving quality of life. As a minimally invasive procedure, PELD has the ability to remove encroaching mass and decompress the spinal and nerve root with minimal trauma. What is more, PELD can co-work with radiofrequency ablation to destroy invaded nerve roots so as to improve radiculalgia .
腰椎椎体转移瘤
晚期恶性肿瘤包括乳腺癌、肺癌、肾细胞癌、前列腺癌等，可侵犯椎体，引起顽固性疼痛和病理性椎体骨折。椎管受侵犯后也会导致脊髓和神经根受压。根据晚期恶性肿瘤的严重程度，治疗的目的可以分为减轻症状和提高生活质量。作为一种微创技术，PELD能够清除转移的肿块并行脊髓和神经根减压。并且，PELD可行射频消融术，从而毁损受累的神经根，从而改善神经根痛。
Lumbar Discal Cyst
Discal cyst is a rare lesion of the intervertebral disc. Unlike typical degenerative disc diseases (DDDs), sciatalgia (75%) is the most common symptom of discal cyst, followed by low back pain (58%). Signs of nerve root compression, including motor deficit (40%) and hyposthesia (30%), are predominant signs. Though spontaneous regression has been reported in some cases, most symptomatic discal cysts require surgical treatment. It is generally realized that discal cyst is related to DDDs, and PETD is able to resect cysts protruding into the spinal canal and repair the broken annulus effectively. Kim et al first reported discal cyst cases addressed by PETD, in which postoperative radiograph showed nerve root decompression and symptoms were relieved significantly. Ha et al also applied PETD to treat discal cyst in 8 patients. Scores for the Visual Analog Scale (VAS)-leg decreased from 8.25 (± 0.5) to 2.25 (± 2.21) and 4 cases were classified as excellent, 3 as good, and 1 as fair; therefore the rate of excellent or good was 87.5%, according to Macnab criteria. However, the literature on lumbar discal cyst treated by PELD remains sparse, so studies of larger sample size are needed in the future.
腰椎间盘囊肿
椎间盘囊肿是一种罕见的椎间盘病变。与典型的退行性椎间盘疾病不同，椎间盘囊肿最常见的症状是坐骨神经痛（75%），其次是下腰痛（58%）。神经根受压的主要体征包括运动障碍（40%）和感觉减退（30%）。虽然自发性吸收在一些病例中已有报道，但大多数有症状的椎间盘囊肿需要手术治疗。人们普遍认为椎间盘囊肿与DDDs有关，PETD可以有效的切除突出到椎管内的囊肿并修复断裂的纤维化。Kim等人首次报道了经PETD治疗的椎间盘囊肿病例，术后影像学检查显示神经根已经减压，并且症状明显减轻。Ha等人还应用PETD治疗了8例椎间盘囊肿。视觉模拟量表（VAS）下肢评分从8.25（±0.5）下降到2.25（±2.21），4例为优，3例为良，1例为可，因此根据Macnab评分优良率为87.5%标准。但是目前，关于PELD治疗腰椎间盘囊肿的文献尚不多见，故未来需要进行大样本的研究。
Recurrent Lumbar Disc Herniation
Recurrent lumbar disc herniation is often identified as disc herniation occurring in the same segment 6 months after the primary surgery. Incidence of recurrence ranges from 2% to 18% according to different surgical options. Risk factors of LDH recurrence include male gender, older age (> 50 years), smoking habit, spinal trauma history, and central LDH. Scar tissue caused by primary surgery makes open revision harder as well as increases the risk of dural tear and nerve injury. In addition, posterior spinal stability is destroyed and secondary degenerative disc diseases are induced due to the resection of posterior lumbar structure once more. Revision surgery through PELD keeps away from the scar tissue and prevents complications such as bleeding, dural tear, and nerve injury within a shorter operation time.
复发性腰椎间盘突出症
复发性腰椎间盘突出症常指初次手术后6个月发生在同一节段的椎间盘突出。根据手术方式的不同，复发率从2%到18%不等。LDH复发的危险因素包括男性、年龄较大（>50岁）、吸烟习惯、脊柱外伤史和中央型LDH。初次手术造成的疤痕组织使开放性翻修手术更困难，也增加了硬脑膜撕裂和神经损伤的风险。此外，再次切除腰椎后部的结构，会进一步破坏了脊柱后部的稳定性，诱发继发性椎间盘退行性病变。PELD翻修术可以避开瘢痕组织，并且能在较短的时间内完成手术，从而预防出血、硬脑膜撕裂和神经损伤等并发症。
联系客服
