下终板直接法在椎板间隙入路椎间孔镜治疗腰椎间盘突出症中的应用

THE APPLICATION OF INFERIOR ENDPLATE DIRECT METHOD IN THE TREATMENT OF LUMBAR DISC HERNIATION VIA INTERLAMINAR ENDOSCOPY SPINE SYSTEM

目的：探讨下终板直接法在椎间孔镜椎板间隙入路治疗腰椎间盘突出症中的安全性和有效性。方法：选择2013年5月～2014年5月收治的腰椎间盘突出症患者165例,L4/5椎间盘突出20例,L5/S1椎间盘突出145例,均采用下终板直接法椎板间隙入路行椎间孔镜椎间盘摘除术。采用视觉模拟评分法（Visual analog score,VAS）、Oswestey功能障碍指数（Oswestry disability indox,ODI）、Macnab标准及红外热成像评定治疗效果。结果：165例患者平均随访12个月,无神经根损伤并发症,术后腿痛VAS较术前明显降低,有显著性差异（P〈0.05）;术后ODI与术前比较明显下降,有显著性差异（P〈0.05）;根据Macnab标准：优138例,良22例,一般5例,差0例,优良率96.9%。红外热像采集双下肢皮肤的温差术前与术后比较明显下降,有显著性差异（P〈0.05）。结论：下终板直接法椎板间隙入路椎间孔镜治疗腰椎间盘突出症安全、有效。

Objective： To determine the safety and efficacy of inferior endplate direct method for interlaminar endoscopy spine system in the treatment of lumbar disc herniation. Methods： A retrospective review was performed on 165 patients with lumbar disc herniation between May 2013 and May 2014. Twenty patients with L4/5 disc herniation and 145 patients with LJSI disc herniation were performed percutaneous endoscopic interlaminar discectomy by inferior endplate direct method. The postoperation neurological function and pain status was evaluated by the visual analog scale （VAS）, the Oswestry disability indox （ODI） and infrared thermal imaging. The patients＇satisfaction was evaluated by the Macnab criteria. Results： The mean follow-up period was 12 months. The mean preoperative VAS decreased to postoperative at final follow-up respectively. The mean ODI decreased to postoperative at final follow-up, which showed statistical significance （P 〈 0.05）. The excellent and good outcomes were 96.9%. The infrared thermal imaging pointed out that the leg skin temperature of D-value was a significant improvement post-operation compared with pre-operation （P 〈 0.05）. Conclusion： Inferior endplate direct method for percutaneous endoscopic interlaminar discectomy provides a safe and very effective alternative for the treatment of lumbar disc herniation.