全内镜经椎板间隙靶向治疗腰椎间盘突出症手术策略及疗效分析

The strategy and early clinical outcome of targeted percutaneous full-endoscopic lumbar discectomy through interlaminar approach

目的分析全内镜经椎板间隙入路靶向穿刺间盘切除术治疗腰椎间盘突出症的安全性和临床疗效。方法收集2013年8月至2015年9月我院收治的单节段腰椎间盘突出患者69例,男29例,女40例,平均年龄45.4岁。所有患者行全内镜经椎板间隙入路靶向穿刺间盘切除术。记录手术时间及髓核取出量,采用疼痛视觉模拟评分(VAS评分)、功能障碍指数(ODI评分)及改良Macnab评分评定疗效,术后1周内复查腰椎MRI评估突出髓核摘除及神经根减压情况。结果平均手术时间88min,术中无并发症发生,取出间盘组织平均体积2.7m L。术后1周内复查腰椎MRI均提示突出髓核摘除彻底、神经根减压充分。随访均超过12个月。术前VAS评分为(7.36±1.19)分,术后12个月为(1.27±0.63)分;术前ODI为(62.30±8.48)%,术后12个月为(8.07±2.30)%,术后12月VAS评分、ODI评分均较术前改善,差异有统计学意义(P<0.01);术后12月Macnab评分54例优,12例良,3例可,优良率95.6%。结论全内镜经椎板间隙入路靶向穿刺间盘切除术治疗腰椎间盘突出症是一种安全、有效的微创脊柱外科技术。

Objective To analyze the surgical targeted strategy, safety and clinical outcome of minimally invasive targeted percutaneous endoscopic lumbar discectomy （PELD） through interlaminar approach. Methods A retro- spective review was performed on 69 patients （29 males and 40 females） with lumbar disc herniation between August 2013 and September 2015 in our hospital. The average age was 45.4 years old. All 69 patients were trea- ted with targeted percutaneous endoscopic lumbar discectomy through different targeted surgery, the time of opera- tion and the volume of removal intervertebral disc were recorded. Lumbar MRI was used to evaluate the removal of herniation and decompression of nerve root within one week after operation. The pain visual analogue scale （ VAS score） , Oswestry disability index （ODI score） and modified Macnab score were used to evaluate the cura- tive effect. Results All operations were successfully completed. The mean operation time was 88 min, no complica- tions occurred during the operation. The mean quantities of reseetable nucleus pulposus was 2.7 ml. The lumbar MPd was revealed that the nucleus pulposus was completely removed and the nerve root decompression was suffi- cient. The mean VAS score improved from （7.36 ± 1.19） at preoperation to （1.27 ±0.63） at last follow- up. The mean ODI score was improved from （62.30 ± 8.48） % to （8.07 ±2.30） %. Follow up 12 months after op- eration, postoperative VAS score and ODI score was lower than preoperative and the difference was statistically significant. Macnab score was excellent in 54 cases, good in 12 cases and fine in 3 cases. The excellent and good rate was 95.6%. Conclusion Minimally invasive targeted percutaneous endoscopic lumbar discectomy through in- terlaminar approach is a safe and effective surgical technique for lumbar disc herniation.