完全内窥镜下经椎板间入路手术治疗腰椎间盘突出症

Primary study of full-endoscopic interlaminar approach for lumbar disc herniation

目的:评价完全内窥镜(full-endoscopic,FE)下经椎板间入路手术治疗腰椎间盘突出症的效果。方法: 2008年8月～2009年2月应用FE下经椎板间入路手术治疗30例腰椎间盘突出症患者,男16例,女14例;年龄20～52岁,平均36.1岁;病程15～120d,平均66d。患者均伴有不同程度的腰痛和单侧坐骨神经痛。经临床和影像学检查均为单节段病变,L5/S1 24例,L4/5 6例。突出类型:侧方型18例,旁中央型8例,游离型4例。术前、术后3个月和末次随访时应用视觉模拟评分(visual analogue scale,VAS)对患者腿痛和腰痛进行评定,记录手术时间、术中及术后并发症。结果:2例转为开放小切口手术,其余28例顺利完成手术,术中出血量少未予估计。2例出现硬膜小裂口,无神经根损伤及术后出血等并发症。手术时间45～105min,平均70.7min;住院时间 3～7d,平均5.7d,伤口均一期愈合。26例患者出院时下肢痛消失,2例减轻。术后随访1.0～1.5年,平均1.3年,无复发病例。腿痛VAS术前、术后3个月和末次随访时分别为76.8mm、7.6mm和7.3mm,术后3个月与术前比较有显著性差异(P<0.01),末次随访与术后3个月比较无显著性差异(P>0.05);腰痛VAS术前、术后3个月和末次随访时分别为18.8mm、11.0mm和10.7mm,术后3个月与术前比较有显著性差异(P<0.01),末次随访与术后 3个月比较无显著性差异(P>0.05)。结论:FE下经椎板间入路手术治疗腰椎间盘突出症可获得良好的临床疗效,同时具有创伤小、出血量和并发症少、术后恢复快等优势。

Objective：To evaluate the primary outcome of full-endoscopic（FE）interlaminar approach for lumbar disc herniation.Method：A retrospective study of 30 cases including 16 males and 14 femles undergoing full-endoscopic interlaminar approch due to lumbar disc hernation from Aug.2008 to Feb.2009 was carried out,the age ranged from 20-52 years（mean 36.1 years）.All patients had single level involved,with 24 in L5/S1 and 6 in L4/5.The mean course of disease was 66 days.All patients presented back pain and sciatica of varied degree,and MRI examination was performed in all patients before surgery.The pathological type of disc herniation included：18 lateral,8 paramiddian and 4 prolapse.The complications,operating time,blood loss and clinical outcome were reviewed retrospectively.The visual analogue scale（VAS）was used to evaluate the leg pain and back pain.Result：2 cases eventually experienced open surgery due to failed primary operation,and 2 cases had dural matter teared.No serious complication such as postoperative bleeding and nerve injury was noted.The average operating time was 70.7min（range,45-105min）with little blood loss.The mean hospital stay was 5.7d（range,3-7d）,no infection was noted in any case,26 cases had leg pain relieved completely after operation,2 case only had partial relief.Patients were followed up for an average of 1.3 years（range,1.01.5 years）and no recurrence was noted thereafter.VAS for leg pain was 76.8mm,7.6mm and 7.3mm for preoperative,3 months and final follow-up respectively,which showed significant difference between preoperative and postoperative（P0.01）,while no difference between two postoperative score（P0.05）.VAS for back pain was 18.8mm,11.0mm and 10.7mm for preoperative,3 months and final follow-up respectively,which showedsignificant difference between the preoperative and postoperative（P0.01）,while no difference between two postoperative parameters（P0.05）.Conclusion：Full-endoscopic interlaminar approach for lumbar disc herniation presents good clinical outcomes due to its minimal invasion,less complications and good prognosis.