经椎板间隙内镜下L_5～S_1椎间盘摘除术疗效观察被引量：2

Clinical observation of the outcome of full-endoscopic L_5～S_1 discectomy through interlaminar approach

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摘要目的：总结经椎板间隙入路内镜下L5∽S1椎间盘摘除手术经验并评价其临床效果。方法将32例椎间盘突出患者根据L5∽S1椎间盘突出物与S1神经根的位置关系分成腋型（14例）、腹型（11例）及肩型（7例）。均采用经椎板间隙内镜下摘除L5∽S1椎间盘。术后第3天、3个月复查腰椎MRI评估椎间盘切除的情况，记录术前及术后3、6、12个月的腰、腿痛视觉模拟评分（ VSA）和功能障碍指数（ ODI），记录术后12个月的腰椎MacNab评分，根据Roberts 标准和MRI评价椎间隙高度。结果手术时间30∽85（45．3±15．8） min。患者均获随访，时间18∽42（25．8±8．4）个月。椎间隙高度分级评分：术前为（2．13±0．56）分，术后末次随访为（2．63±0．61）分，差异有统计学意义（P〈0．01）。无神经损伤、感染及其他手术并发症。1例术后复发，椎间盘再次突出，通过内镜下再次椎间盘翻修术后随访17个月无复发。术后3、6、12个月腰、腿痛VAS及ODI评分均较术前明显降低（P〈0．01）；术后12个月时MacNab评分：优22例，良8例，可1例，差1例。术后随访12个月时S1神经根功能状态：神经根支配区感觉和肌力较术前明显改善（P〈0．01），而跟腱反射和术前相比恢复不明显（P〉0．05）。结论经椎板间隙内镜下手术治疗L5∽S1椎间盘突出手术安全，时间短，是治疗非包含型椎间盘突出的有效方法。 Objective To summarize the experience of full-endoscopic L5 ∽S1 discectomy through interlaminar ap-proach and evaluate its clinical effect. Methods 32 cases of imtracanalicular non-contained disc herniations at the L5 ∽S1 level were treated with full-endoscopic discectomy through interlaminar approach. L5 ∽S1 disc herniation was divided into three types according to position of herniated disc related to S1 nerve root：axilla type （14 cases）, ventral type （11 cases）, shoulders type （7 cases）. Axilla approach were selected for axilla type with the endoscope and worked channel placed at the axilla between S1 nerve root and dural sac while shoulder approach were selected for ventral type and shoulder type with the endoscope and working channel placed at the shoulder lateral to S1 nerve root. Prolapsed or sequestered disc materials were resected with intradiscal loosening tissue taken out simultaneously through the same approach. MRI was reexamined 3 days and 3 months after operation to evaluate the resection com-pleteness of prolapsed disc material. Visual analogue scales （ VAS） of low back pain and sciatica, Oswestry disability index （ODI） of preoperative, postoperative 3,6,12 months were recorded and compared. MacNab scores were evalu-ated in the 12-month follow-up. The intervertebral space height was evaluated by Robert standard and MRI. Results Operation time was 30∽85（45. 3 ± 15. 8） min. All cases were followed up for 18∽42（25. 8 ± 8. 4） months. The preoperative value of the intervertebral space height was 2. 13 ± 0. 56, while that was 2. 63 ± 0. 61 of the final follow-up value. There were significant differences （ P〈0. 01 ） . No nerve injury and infection were complicated. Only 1 case of reoccurrence was revised with microendoscopic discectomy no recurrence in 17 months follow-up. Postopera-tive ODI and VAS of lowback pain and sciatica were significantly decreased in 3,6,12 months （P〈0. 01）. MacNab scores of postoperative 12 months follow-up included excellent in 22 cases, good in 8, fair in 1 and poor in 1. The functional status of S1 nerve in the 12 months follow-up postoperatively：the feel and muscle power function of S1 nerve root area increased significantly （P〈0. 01）,no significantly altered in Achilles tendon reflex,compared with the pre-operation （ P〉0. 05 ） . Conclusions Full-endoscopic L5 ∽S1 discectomy through interlaminar approach is a safe, rational and effective minimally invasive spine surgery technique with excellent clinical short-term outcomes.

作者黄金河赵玉驰王力刚许军

机构地区深圳市第七人民医院骨科

出处《临床骨科杂志》 2015年第4期410-413,共4页 Journal of Clinical Orthopaedics

关键词经皮内窥镜椎间盘摘除术腰椎间盘突出症微创脊柱外科 percutaneous endoscopy discectomy lumbar disc herniation minimally invasive spine surgery

分类号 R681.5 [医药卫生—骨科学] R687.3 [医药卫生—骨科学]

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