经皮微创治疗腰_5-骶_1椎间盘突出症入路选择

The choice of approach for minimally invasive percutaneous treatment of L_5-S_1 disc herniation

目的探讨经皮微创治疗腰_5-骶_1椎间盘突出症不同入路的适应证及其临床效果。方法2011-03-2014-12,采用射频热凝联合臭氧消融术治疗腰_5-骶_1椎间盘突出症208例,对比各种入路的穿刺成功率、手术时间、术后治疗效果,并结合患者影像学特征加以分析。结果经髂骨钻孔入路穿刺成功率最高,后外侧入路则最低;手术时间后方入路最短,后外侧入路耗时最长;手术疗效则是经髂骨钻孔入路与后外侧入路相近,均优于后方入路。结论经皮微创治疗腰_5-骶_1椎间盘突出症,后外侧入路是经典的方法,但穿刺成功率不及后方入路;经髂骨钻孔入路提高了穿刺成功率,但增加了创伤,适用于高髂嵴及骨增生严重患者。

Objective To explore the indication and clinical effects of the minimally invasive percutaneous treatment for L5-S1 disc herniation through different approaches. Methods From March 2011 to December 2014, 208 patients suffered from L5-S1 disc herniation were treated by radiofrequency thermocoagulation and ozone ablation. Success rate of operation, operation time,postoperative treatment effect in different periods were comparatively analyzed respectively. According to the imaging characteristics of each case, the degree of difficulty was judged and approach was chosen subsequently. Results The highest success rate appeared at the group of drilling lilac bone hole approach, while the lowest at the group of posterolateral approach. It spent the shortest operation time when through posterior approach and longest time through posterolateral approach. Postoperative treatment effect of the group of drilling iliac bone hole approach was similar to the group of posterolateral approach, however, both of which were better than those of the group of posterior approach. Conclusion As the classic method, posterolateral approach showed good effect on the minimally invasive percutaneous treatment for L5-S1 disc herniation. Furthermore,the way through drilling iliac bone hole approach got high success rate and acceptable clinical effect, fits for the high iliac crest cases, although increasing the invasion to the patients.