腰椎椎间盘突出症经椎板间和经椎间孔入路内镜治疗的比较研究

Comparison of percutaneous endoscopic via interlaminar and transforaminal approach for lumbar disc herniation

目的探讨经皮内镜治疗L5/S1腰椎椎间盘突出症的入路选择。方法 2011年8月～2012年8月符合入选条件的68例L5/S1腰椎椎间盘突出患者按入院奇偶顺序分成2组,椎板间入路组34例,椎间孔入路组34例。对2种手术入路的手术时间、透视次数、术中患者耐受情况、患者疗效满意度、术后残余症状、并发症及术前术后疼痛视觉模拟量表(visual analogue scale,VAS)评分进行比较。结果椎板间入路组有4例术中改为椎间孔入路,椎间孔入路组有7例改为椎板间入路,经椎板间入路和椎间孔入路手术时间分别是(50.2±7.0)min、(61.9±9.6)min(P<0.05),术中透视次数分别为5.4±2.3次、10.3±2.5次(P<0.05),2种入路治疗后腿痛术后即刻及术后3个月VAS评分与术前相比差异均有统计学意义(P<0.05)。改良MacNab标准评定2组间差异无统计学意义(P>0.05)。结论经皮内镜下治疗L5/S1腰椎椎间盘突出症经椎板间或经椎间孔入路治疗各有特点,且均能取得优良的临床疗效,但需针对患者的解剖情况、影像定位及临床表型选择适宜的个体化手术入路。

Objective To discuss approach selection of L5/S1 lumbar disc herniation treated by percutaneous endoscopy. Methods From August 2011 to August 2012, 68 patients with L5/S1 disc herniation admitted were divided into 2 groups by admission parity order, 34 patients in interlaminar approach group, 34 cases in transforaminal approach group, compared operation time, fluoroscopy times, patients’ tolerance , therapy efficacy, postoperative residual symptoms, complications and preoperative and postoperative visual analogue scale （VAS） scores. Results Four cases changed to transforaminal approach in interlaminar group, 7 cases changed to interlaminar approach in transforaminal group, interlaminar group and transforaminal group operation time was （50.2±7.0）min,（61.9±9.6）min（P〈0.05）; perspective times were 5.4±2.3, 10.3±2.5（P〈0.05）, compared leg pain VAS score postoperative and after surgery 3 months to preoperative, there were statistically significant （P〈0.05）. The improved MacNab was no statistically significant between 2 groups （P〉0.05）. Conclusion L5/S1 lumbar disc herniation treated by percutaneous endoscopic via interlaminar and transforaminal approach have achieved excellent clinical efficacy. But the patient’s anatomy, image positioning and clinical symptom should be combined to develop appropriate individualized surgical approach.