全内窥镜下椎板间入路治疗腰5骶1椎间盘突出症

Full-endoscopic interlaminar approach in the treatment of L5S1 disc herniation

目的探讨全内窥镜下椎板间入路腰椎间盘切除术治疗腰_5骶_1椎间盘突出症的临床疗效。方法对21例腰_5骶_1椎间盘突出症患者进行全内窥镜下椎板间入路腰椎间盘切除术。依据视觉模拟量表(Visual Analogue Scale,VAS),功能障碍指数(Oswestry Disability Index,ODI)和Macnab腰腿痛评定标准进行疗效评定。结果随访4~12月,平均6月。下肢神经痛VAS评分术前6.2±1.3分,术后1周1.5±0.6分,术后3月1.0±0.4分,手术前后结果差异有统计学意义(P<0.05);ODI评分术前65.1±12.6,术后1周18.4±6.3,术后3月12.5±2.9,手术前后结果差异有统计学意义(P<0.05);Macnab腰腿痛评定标准结果为优16例,良3例,可2例,优良率90.5%。结论全内窥镜下椎板间入路治疗腰_5骶_1椎间盘突出症创伤小,对脊柱稳定性破坏小,操作精细,术后恢复快,近期手术效果优良。因其不受髂棘影响,特别对于高髂棘、不易从侧方椎间孔入路治疗的患者,减少了对神经根的损伤,降低了手术并发症及失败率。

Objective To evaluate the clinical efficacy of full-endoscopic interlaminar approach lumbar discectomy in the treatment of L5-S1 disc herniation. Methods 21 patients with L5-S1 disc herniation were treated with full-endoscopic interlaminar approach lumbar disceetomy. The clinical effect was evaluated based on visual analogue scale （VAS）, Oswestry disability index（ODI） and Macnab low back pain assessment standards. Results The average follow-up time was 6 months （ranged from 4 to 12 months）. Lower extremity neuropathic pain＇s VAS score decreased from（6.2±1.3） before surgery to （1.5±0.6） one week after surgery and （1.0±0.4） three months after surgery, the difference was statistically significant（P〈0.05）; ODI score decreased from （65.1±12.6） before surgery to （18.4±6.3） one week after surgery and （12.5±2.9） three months after surgery, the difference was statistically significant （P〈0.05）. At Macnab low back pain assessment standards, excellent in 16 cases, good in 3 cases, fair in 2 cases, the excellent and good rate was 90.5%. Conclusion Full-endoscopic interlaminar approach in the treatment of L5-S1 disc herniation has minimally invasion, small damage for spinal stability, fine operation, quick recovery and recently good surgical results. Because it is not affected by iliae spine, especially for the patients with high-lilac spine and not easy treated from the postlateral transforaminal approach, full-endoscopic interlaminar approach treatment can reduce the damage of nerve root, surgical complications and failure rate.