经皮内镜椎板间入路治疗腰椎间盘突出症42例报告

Percutaneous endoscopic lumbar discectomy through trans-interlaminar approach in the treatment of lumbar disc herniation:42 cases

目的探讨经皮内镜椎板间入路髓核摘除术fpercutaneousendoscopiclumberdiscectomy，PELD）治疗腰椎间盘突出症（1umberdischerniation，LDH）的临床疗效。方法对2011年9月至2012年8月采取经皮椎板间隙入路椎间孔镜下髓核摘除术治疗的42例IJ5，s，腰椎间盘突出症患者进行回顾性分析，采用疼痛视觉类比评分（visualanaloguescale，VAS）和Oswestry功能障碍指数（oswestrydisabilityindex，ODI）评估临床疗效。其中，男29例，女13例；平均年龄39．2（21—55）岁；平均病程9．3（5—16）个月。42例均为单倾II，突出或旁中央型，突出21例，脱出15例，游离脱垂6例。结果所有病例均顺利完成手术，平均手术时间68．7（50～100）min；平均出血量10．8（5～20）ml；平均术后住院时间3．5（2—7）天；术后均获随访，平均随访8．4（5～13）个月。出院时VAS评分为（3．0±0．6）分，与术前（7．2±1．1）分相比，差异有统计学意熨（P〈0．001），末次随访时VAS评分为（12．0±0．8）分，又有进一步改善（P〈0．001）。末次随访时ODI评分为（17．6±4．4）分，较术前（64．8±5．5）分有明显改善（P〈0．001）。术中s。神经根挫伤导致躅跖屈肌力下降2例，经保守治疗后恢复正常或症状好转；硬膜囊撕裂1例，但术后未出现脑脊液漏；1例术后复发再次行翻修术。结论经皮椎板间隙入路椎间孔镜下髓核摘除术创伤小，操作安全、术后恢复快，临床疗效满意，尤其对于髂嵴较高的L5，S1腰椎间盘突出症患者具有独特的优势。

Objective To investigate the clinical outcomes of percutaneous endoscopic lumbar discectomy （ PELD ） through trans-interlaminar approach in the treatment of lumber disc herniation. Methods A retrospective study was performed on 42 patients with L5, s1 lumbar disc herniation who underwent PELD through trans-interlaminar approach from September 2011 to August 2012. The Visual Analogue Scale （ VAS ） and Oswestry Disability Index （ ODI ） were used to assess the clinical outcomes. There were 29 males and 13 females, with an average age of 39.2 years old （ range; 21-55 years ）. The mean course of disease was 9.3 months （ range; 5-16 months ）. All patients were unilateral prominent or paracentral type, including prominent in 21 cases, prolapse in 15 cases and free prolapse in 6 cases. Results The surgeries were performed on all patients successfully, and the average operation time was 68.7min （ range; 50-100 min ）. The mean blood loss was 10.8ml （ range： 5-20 ml ）, and the mean postoperative hospital stay was 3.5 days （ range; 2-7 days ）. All patients were followed up for a mean period of 8.4 months （ range： 5-13 months ）. The VAS score at discharge was （ 3.0-0.6 ）, and there were statistically significant differences when compared with that preoperatively （ P〈0.001 ）. The VAS score in the latest follow-up was （ 2.0-3：0.8 ）, which was further improved （ P〈0.001 ）. The ODI score in the latest follow-up was （ 17.6±4.4 ）, which was significantly improved when compared with those preoperatively （ P〈0.001 ）. The strength of flexor hallucis longus was decreased in 2 patients due to the intraoperative S1 nerve root injuries, who got recovered or whose symptoms got improved after the conservative treatment. Dural tear occurred in 1 case, without the cerebrospinal fluid leakage postoperatively. 1 patient underwent revision surgery due to the postoperative recurrence. Conclusions With minimal invasion, safe operation, rapid postoperative recovery and good clinical outcomes, PELD through trans-interlaminar approach is suitable for the patients with higher iliac crest and L5, S1 lumbar disc herniation in particular.