经椎板间入路椎间孔镜治疗下段腰椎间盘突出症

Transforaminal endoscopy through interlaminar approach for inferior lumbar disc herniation

目的探讨后路经椎板问小关节突与硬膜囊间隙入路椎间孔镜下手术治疗L4／L5、L5／S1椎间盘突出症（LDH）的疗效。方法回顾性分析2013年1月至2014年9月后路经椎板问小关节突与硬膜囊间隙入路椎间孔镜下手术治疗的76例L4／L5、Ls／S。LDH患者的临床资料，男46例，女30例；年龄22．78岁，平均56．2岁；责任间隙：L4／L5椎间盘34例，L5／S。椎间盘42例。所有患者分别于术前、术后1周、术后1个月、术后3个月采用视觉模拟评分（VAS）和日本骨科协会（JOA）评分对患者的疼痛、麻木、肌力、运动等进行评定。结果手术均顺利完成，术后无神经根损伤及硬膜囊撕裂、椎间盘炎等并发症发生，手术切口均获Ⅰ期愈合。所有患者术后获12—18个月（平均14个月）随访，无治疗间隙复发。所有患者术后1周、术后1个月、术后3个月的VAS评分、JOA评分分别与术前比较差异均有统计学意义（P〈0．05）；而术后1周、术后1个月、术后3个月的VAS评分、JOA评分间比较差异均无统计学意义（P〉0．05）。结论后路经椎板间小关节突与硬膜囊间隙入路椎间孔镜下手术治疗L4／L5、L5／S1 LDH在严格掌握手术适应证的前提下，具有安全性高、创伤小、出血少、并发症少、康复快等优势。

Objective To study the efficacy of transforaminal endoscopy through interlaminar approach for intervertebral disc herniation （LDH） at L4/L5 and L5/S1. Methods Between January 2013 and September 2014, 76 patients with LDH at L4/L5 and L5/S1 were treated at our department through the posterior intertaminar approach between the facet process and dural sac clearance. They were 46 men and 30 women, 22 to 78 years of age （56.2 years）. The responsible level was at L4/L5 in 34 eases and L5/S1 in 42 ones. All the patients were assessed preoperation, 1 week, 1 and 3 months postoperation using visual analogue scale （VAS） and Japanese Orthopaedic Association （JOA） scoring in terms of pain, numbness, muscular strength and motion. Results All surgeries succeeded with no injury to nerve root, dural sac disruption, or spondylodiseitis. All wounds healed primarily. The patients obtained an average follow-up of 14 months （range, from 12 to 18 months）. No relapse was found during the follow-ups. There were significant differences in VAS and JOA scores between preoperation and all the time points postoperation in all the patients （ P 〈 0. 05） ; there were no sig- nificant differences in VAS and JOA scores between 1 week, 1 and 3 months postoperation in all the patients （ P 〉 0. 05 ）. Conclusion Transforaminal endoscopy through interlaminar approach for LDH at L4/L5 and L5/S1, if its indications are strictly followed, can have the advantages of high safety, limited invasion, little bleeding, few complications and quick recovery.