椎板间入路椎间孔镜下摘除L5/S1椎间盘突出髓核技术改进探讨

Technical improvement of percutaneous endoscopic lumbar discectomy for l5/s1 disc herniation via interlaminar approach

目的探讨椎间孔镜经椎板间隙摘除腰5骶1椎间盘突出髓核手术操作技巧。方法 2012年1月-2013年7月,我科对30例高髂嵴腰5骶1椎间盘突出症患者,实施了经椎板间隙入路椎间孔镜下摘除突出髓核手术。结果术毕下肢麻木减轻5例,麻木无改善4例,麻木加重1例。无感染及硬膜囊撕裂等并发症。平均随访6.8个月,所有下肢麻木病例均恢复正常。术前术后腰腿痛VAS评分差异有显著性(P<0.05)。术后3个月Oswestry功能障碍指数(ODI)疗效评分较术前显著改善(P<0.05)。结论腰5骶1椎间盘突出症伴高髂嵴患者的微创手术,椎板间入路经皮内镜术是较好的选择,但是其狭小操作空间、增强安全性、适应证窄极具挑战性。

【Objective】To investigate operative skills of percutaneous endoscopic lumbar discectomy for L5/S1 disc herniation via interlaminar approach. 【Methods】From January 2012 to July 2013, 30 patients with L5/S1 disc herniation were underwent percutaneous endoscopic lumbar discectomy via interlaminar approach. 【Results】At the end of surgery leg numbness improved in 8 cases, no improved in 4 cases, sharpen in one case. No infection and dural injuries were occurred in all cases. Average follow-up was 6.8 months, all leg numbness disappeared. The preoperative and postoperative visual analogue scale（VAS） were used to evaluate the back pain and the leg pain（P〈0.05）. According to Oswestry Disability Index（ODI） for the functional status, the results of ODI demonstrated improvement post-surgery 3 months compared with pre-surgery（P〈0.05）. 【Conclusion】Percutaneous endoscopic lumbar discectomy for L5/S1 disc herniation with high iliac crest via interlaminar approach was a better choice. But its security, small operational space and narrow indications were challenged.