经皮内镜椎间孔入路治疗极外侧腰椎间盘突出症

Percutaneous endoscopic surgery for far lateral lumbar disc herniation with an inter-vertebral foramen approach

目的探讨经皮内镜椎间孔入路治疗极外侧腰椎间盘突出症的安全性和疗效。方法 2007年12月-2009年3月,对16例确诊为极外侧腰椎间盘突出症患者在C臂X线机引导下采用经皮内镜椎间孔入路直视下气化切除突出的髓核组织,减压和松解受累神经根。采用视觉模拟评分法(VAS)对术前、术后1个月及末次随访患者疼痛状况进行评分,末次随访同时采用改良MacNab标准进行疗效评价。结果所有病例手术均顺利完成,手术时间40～90min,平均65min;出血量20～180ml,平均40ml;随访2-12个月,平均4个月。术后1个月及末次随访时与术前比较VAS评分均有显著性差异(P<001);按照Macnab标准评定,本组优12例,良2例,可2例。结论经皮内镜椎间孔入路治疗极外侧腰椎间盘突出症是安全有效的微创手术。

Objective To investigate the safety and efficacy of percutaneous endoscopic surgery with an intervertebral foramen approach in the treatment of far lateral lumbar disc herniation （FLDH）. Methods From December 2007 to March 2009, 16 patients diagnosed with far lateral lumbar disc herniation underwent percutaneous endoscopic surgery C-arm with an intervertebral foramen approach under the instruction of C-arm x-ray machine, of which pneumatolytic discectomy of herniated nucleus pulposus was performed under direct vision. Besides, decompression was performed, and the involved nerve roots were released. According to the visual analog scale （VAS）, the pain level of the patients pre-operatively, 1 month post-operatively, and of the last follow-up was assessed. During the last follow-up, the efficacy was evaluated according to the modified MacNab standard. Results For all the patients, the surgery was completed successfully, with the mean operation time being 65 minutes （range, 40-90 minutes） and the mean blood loss being 40 ml （range, 20-180 ml）. The mean follow-up was 4 months （range, 2-12 months）. There was a significant difference of the VAS results between the patients in 1 month post-operatively and of the last follow-up and the patients pre-operatively （P〈0.01）. According to the modified MacNab standard, 12 cases were excellent, 2 good, and 2 effective. Conclusions Percutaneous endoscopic surgery for far lateral lumbar disc herniation with an inter-vertebral foramen approach is safe and effective.