经肌肉间隙套管椎板间入路微创治疗下腰椎椎间盘突出症

Minimally invasive therapy for lower lumbar disc herniations via intermuscular space cannular and interlaminar approach

目的探讨经肌肉间隙套管椎板间入路微创治疗下腰椎椎间盘突出症的手术技巧及临床疗效。方法回顾性分析32例下腰椎椎间盘突出症病人的临床资料,均行经肌肉间隙套管椎板间入路微创治疗。并采用疼痛视觉模拟评分(VAS)、oswestry功能障碍指数(ODI)评价临床疗效。结果手术切除突出髓核32例,平均手术时间(62.4±13.6)min,术中出血量(31.0±5.6)ml,32例病人术后腰腿痛及感觉、肌力减退均有不同程度好转。32例随访6~12个月,平均8.5个月。术前与术后不同时段腰痛、腿痛VAS评分及ODI评分比较均有统计学差异(P<0.01)。随访期间无腰椎间盘突出症复发病例。结论神经外科显微镜下经肌肉间隙套管椎板间入路微创治疗下腰椎椎间盘突出症具有创伤小,出血少,显露清楚,神经根减压彻底,对脊柱稳定性破坏小,术后恢复快等优点;其近期疗效明确,远期效果需进一步随访。

Objective To investigate the surgical technique and clinical efficacy of minimally invasive therapy for lower lumbar disc herniation（LLDH） via intermuscular space cannular and interlaminar approach. Methods Clinical data of 32 patients with LLDH undergoing minimally invasive surgery via intermuscular space cannular and interlaminar approach were analyzed retrospectively. The clinical efficacy was evaluated by visual analogue scale（VAS） and oswestry disability index（ODI）. Results The lumbar nucleus pulposus was removed in 32 patients, the mean operation time was 62.4 ± 13.6 min, and the intraoperative blood loss was 31.0 ± 5.6 ml.The lumbocrural pain, hypaesthesia and muscle strength reduction were improved in different degree in 32 patients. All the patients were followed up for the mean time of 8.5 months, ranging from 6 to 12 months. There were significant differences in VAS and ODI scores between preoperation and postoperation（P 0.01）, and no LLDH patient recurred during the follow-up period. Conclusions Intermuscular space cannular and interlaminar approach under microscope has the advantages of less trauma, less bleeding, clear exposure, complete decompression of the nerve root, less damage to the stability of spinal column, quick recovery after operation for patients with LLDH. Its short-term efficacy is clear and the long-term efficacy needs further follow-up.