经皮内镜下不同术式治疗腰椎间盘突出症的研究

Comparison of percutaneous endoscopic through different surgical treatment for lumber disc herniation

目的探讨经皮内镜下治疗L5/S1椎间盘突出的术式选择。方法对76例L5/S1椎间盘突出患者按入院证编号奇偶数分为2组,经椎间孔入路组40例,经椎板间入路组36例。对两种术式的手术时间、术中患者耐受度、改变术式率、并发症及术前术后疼痛视觉模拟量表(visual analogue scale,VAS)评分、临床疗效进行比较。结果椎间孔入路组11例改为椎板间入路(27.5%),椎板间入路组手术顺利结束。椎板间入路组较椎间孔入路组手术时间平均缩短25.7 min。所有患者均得到随访,平均15.6个月。术后椎间孔入路组2例出现根性痛觉过敏,经积极治疗3个月后缓解(并发症发生率5%)。两组均无永久性神经根损伤和硬脊膜囊撕裂等并发症。两组(不计椎间孔入路组改变术式者11例)术后各时间点腰痛和腿痛VAS评分较术前均有统计学意义(P<0.05)。术后6个月Mac Nab标准评定2组间差异无统计学意义(P>0.05),总优良率87.7%。结论经皮内镜下椎间孔入路及椎板间入路均能获得满意疗效,但需根据患者的个体情况选择适宜的个体化手术方式。

Objective To discuss approach selection of L5/S1 lumbar disc herniation treated by percutaneous endoscopy. Methods From 2012 February , 76 patients with L5/S1 disc herniation admitted were divided into 2 groups by admission parity order,40 cases in transforaminal approach group,36 patients in interlaminar approach group. Compared operation time, patients ＇ tolerance, rate of surgical approach to change, complications, preoperative and postoperative visual analogue scale （VAS） scores and clinical efficacy. Results Eleven cases changed to interlaminar approach in transforaminal group（27.5 % ） ,the interlaminar approach group operation ended smoothly. Interlaminar approach group compared with the transforaminal group average operation time shortened 25.7min. All patients were followed up for average 15.6 months. Postoperative 2 cases in transforaminal group appeared nerve roots hyperalgesia, 3 months after remission （complication rate 5% ）. No permanent nerve roots and dural sac tear ocurred in the two groups. Between two groups （ excluding 11 cases of change operation in transforaminal group）, compared after each time point of back and leg pain VAS score to preoperative, there were statistically significant （P 〈 0.05 ） . At 6 months after operation,the MacNab was no statistically significant between 2 groups （P 〉 0. 05）, The good recovery rate was 87. 7%. Conclusion Percutaneous endoscopic transforaminal and interlaminar approaches are satisfactory in the effect. But the individual conditions of patients should be combined to develop appropriate individualized surgical approach.