经椎板间隙扩窗入路内窥镜下手术治疗伴椎板间隙狭窄的L5/S1椎间盘突出症

Endoscopic discectomy via interlaminar approach assisted by expanding fenestration for L5/S1 lumbar disc herniation combined with narrowing of interlaminar space

目的：评价采用常规器械扩窗经椎板间隙入路内窥镜下手术治疗伴椎板间隙狭窄的L5／S1椎间盘突出症的可行性。方法：2011年9月～2012年6月应用常规器械扩窗经椎板间隙入路内窥镜下椎间盘切除术治疗伴椎板间隙狭窄的L5／S1腰椎间盘突出症患者45例，其中男29例，女16例；年龄16～53岁，平均35．7岁。突出类型：肩上型25例，腋下型10例，混合型5例，游离型5例。统计手术时间、术中出血量、扩窗咬除骨量及并发症等手术基本情况。术前及术后3d、2周、1个月、3个月、6个月进行腰腿痛视觉模拟评分（VAS）。结果：所有病例均顺利完成手术和各时间点VAS评分。手术时间60～125min，平均83．5min；术中出血约10～50ml，平均25ml。术中扩窗咬除骨量约3～10g，平均6g。术中无神经根损伤、硬膜囊撕裂。术后3例出现下肢麻木感，1周后均恢复，术后无出血、感染等其他并发症。术后各时间点腰腿痛VAS与术前比较有显著性差异（P〈0．05）。结论：采用经椎板间隙入路内窥镜下椎间盘切除术治疗伴椎板间隙狭窄的L5／S1椎间盘突出症时，常规器械扩窗具有较大的安全性，操作步骤简单，不需要复杂昂贵的专门设备。

Objectives： To evaluate the feasibility of endoscopic discectomy via interlaminar approach for the L5/S1 lumbar disc herniation with narrowing of interlaminar space assisted by expanding fenestration which is preliminarily prepared using conventional instruments. Methods： 45 patients suffering from L5/S1 lumbar disc herniation with narrowing of interlaminar space underwent endoscopic discectomy via interlaminar approach assisted by expanding fenestration, which was preliminarily prepared using conventional instruments from September 2011 to June 2012. There were 29 males and 16 females with a mean age of 35.7（range, 16-53 years） years old. The pathological types included nerve root shoulder type in 25 cases, axillary type in 10 cases, mixed type in 5 cases and sequestration in 5 cases. The clinical evaluations of operation time, intraop- erative blood loss, resected bone mass and complication were reviewed. All patients were assessed by visual analog scale（VAS） for lumbar and leg pain during the periods of preoperation, postoperation 3 days, 2 weeks, 1 month, 3 months and 6 months respectively. Results： All patients were followed up at 3d, 2w, lm, 3m, and 6m. The average operation time was 83.5 minutes（range 60-125 minutes）. Intraoperative blood loss was 10-50ml（average 25ml）. There was no nerve root or dural sac injury, no infection was noted. The resected bone mass was about 3-10g （average 6g）. There was a significant improvement in VAS leg pain scores after surgery compared with preoperative ones （P〈0.05）. Conclusions： Endoscopic discectomy via interlaminar ap- proach assisted by expanding fenestration for L5/S1 lumbar disc herniation combined with narrowing of inter- laminar space is safe and reliable, necessitating less comDlicated and expensive equinment.