经皮内镜下椎板间入路结合射频消融技术治疗L5／S1椎间盘突出症

Endoscopy Through Interlaminar Approach Combined with Radiofrequency Ablation for the Treatment of L5/S1 Protrusion of Intervertebrai Disc

【目的】探讨微创脊柱内镜技术经皮椎板间入路结合射频消融技术治疗L5／S1椎间盘突出症的疗效及可行性。【方法】回顾性分析2009年5月至2012年9月，本院应用微创脊柱内镜结合可屈性双极射频电极技术经皮椎板间入路治疗L5／S1椎间盘突出症患者86例，其中男51例，女35例；平均年龄51．2（32～69）岁。依据Yeung分型，中央型11例，旁中央型32例，旁侧型43例。其中伴有钙化者12例；游离髓核33例，根据MRI判断，游离髓核均在椎管一侧，23例髓核向尾侧游离，10例向头侧游离，33例中6例巨大脱垂者游离髓核达椎管后缘。骶髂间距平均39．2mm。临床症状体征与影像学表现相符合。术后随访4～26个月，平均15个月。根据Macnab标准评定疗效。【结果】3例改开放手术，83例手术均顺利完成，其中优43例，良34例，可4例，差2例，优良率89．5％。【结论】选择合适的L5／S1椎间盘突出症病例，尤其是巨大突出或高髂嵴者，采用经皮椎板间入路微创脊柱内镜结合可屈性双极射频电极技术治疗是可行的较好方法。

[Objective] To explore the efficacy and feasibility of minimally invasive spinal endoscopy through interlaminar approach combined with radiofrequency ablation for the treatment of L5/S1 protrusion of intervertebral disc. [Methods] Totally 86 patient with L5/S1 protrusion of intervertebral disc treated with minimally invasive spinal endoscopy combined with flexible dipolar-electrode radiofrequency through interlami- nar approach in our hospital from May 2009 to Sept. 2012 were analyzed retrospectively. Among them, 51 pa- tients were male and 35 patients were female. Their average age was 51.2 years（32-69 years）. According to Yeung typing, 11 patients were central type, and 32 patients were paracentral type, and 43 patients were lat- eral type. Among these patients, there were 12 patients with calcification and 33 patients with free nucleus pulposus. According to the MRI results, all of free nucleus pulposuses were on one side of vertebral canal, and 23 nucleus pulposuses moved towards caudal vertebral canal, and 10 nucleus pulposuses moved towards the head of vertebral canal. Among 33 patients, free nucleus pulposuses of 6 patients with huge prolapse reached to posterior border of vertebral canal with an average sacroiliac spacing of 39.2mm. The clinical symptoms and signs accorded with imaging findings. All patients were followed up for 4-26 months after operation with an average of 15 months. According to Macnab standard, the efficacy was evaluated. [Results] Three patients changed to open operation, and 83 patients completed the operation successfully. The excellent rate was 89.5 %. [Conclusion] Suitable patients with L5/S1 protrusion of irtervertebral disc and especially patients with huge protrusion or high iliac crest should be chosen. Minimally invasive spinal endoscopy through interlaminar approach combined with flexible dipolar-electrode radiofrequency ablation is a feasible and better method.