经椎板间孔入路间断内窥镜下治疗L_5、S_1椎间盘突出症疗效分析

ANALYSIS OF EFFECTIVENESS OF INTERRUPT PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY THROUGH INTERLAMINAR APPROACH FOR L_5,S_1 DISC PROTRUSION

目的探讨经椎板间孔入路间断内窥镜下治疗L5、S1椎间盘突出症的临床效果。方法 2006年11月-2010年8月,收治L5、S1椎间盘突出症115例,其中男79例,女36例;年龄14～79岁,平均38岁。病程2～15个月,平均8.3个月。均表现为S1神经根支配区症状。采用经椎板间孔入路穿刺,建立工作通道。穿刺针测试工作面无神经根或硬膜囊后,使用器械直接摘除椎间盘组织,然后在内窥镜下观察神经根减压情况;游离型的患者在内窥镜下观察神经根压迫情况,摘除神经根周围椎间盘组织,然后进入椎间隙摘除游离的椎间盘组织。结果术中4例穿刺失败,1例改为小开窗手术,3例改为后外斜入路手术;其余采用经椎板间孔入路间断内窥镜技术。术后80例获随访,随访时间12～36个月,平均18个月。术前Oswestry功能障碍指数(ODI)为73%±12%,术后12个月和末次随访时分别为13%±5%和12%±8%,与术前比较差异均有统计学意义(P<0.01);术后12个月和末次随访时比较差异无统计学意义(P>0.05)。末次随访时根据改良的Macnab疗效评定标准进行疗效评定,优59例,良15例,可3例,差3例,优良率92.5%。结论经椎板间孔入路间断内窥镜下治疗L5、S1椎间盘突出症能达到理想的治疗效果,具有手术时间短、创伤小、康复快的特点。

Objective To evaluate the effectiveness of interrupt percutaneous endoscopy lumbar discectomy（PELD） through interlaminar approach for L5,S1 disc protrusion.Methods Between November 2006 and August 2010,115 patients with L5,S1 disc protrusion were treated,including 79 males and 36 females with an average age of 38 years（range,14-79 years）.All patients showed the dominated symptom of the S1 nerve root.The working channel was established by puncturing through interlaminar approach under the local anesthesia.After the needle was used to make sure no nerve root or dural sac on working face,the disc tissue was excised directly by blind sight.Then the nerve root decompression was observed through the endoscope.In patients with free type,fragment compression was observed through the endoscope,and the disc tissue around the nerve roots was removed,then the free disc tissue around intervertebral space was excised.Results One patient who failed to puncture changed to miniopen discectomy;3 patients who failed changed to post lateral approach;and the others underwent interrupt PELD through interlaminar approach.Eighty patients were followed up 18 months on average（range,12-36 months）.The average Oswestry Disability Index（ODI） was reduced to 13% ± 5% at 12 months after operation and to 12% ± 8% at last follow-up from 73% ± 12% at preoperation,showing significant differences（P 〈0.01）.According to modified Macnab,s criterion,the results were excellent in 59 cases,good in 15 cases,fair in 3 cases,and poor in 3 cases at last follow-up,and the excellent and good rate was 92.5%.Conclusion For the treatment of disc protrusion at the L5,S1 level,interrupt PELD through interlaminar approach should be ideal with short operation time,small trauma,and quick recovery.