经皮脊柱内镜技术治疗椎间盘源性马尾综合征5例疗效观察

Effects of Percutaneous Endoscopic Lumbar Discectomy for Cauda Equina Syndrome Caused by Lumbar Disc Herniation:Report of 5 Cases

目的探讨经皮脊柱内镜技术治疗椎间盘源性马尾综合征的临床效果。方法回顾性分析2014年10月～2016年12月采用脊柱内镜技术治疗5例椎间盘源性马尾综合征的临床资料。其中椎间盘突出位于L_5/S_1 3例,L_(4/5)、L_(2/3)各1例。5例均在脊柱内镜下摘除突出椎间盘,行根管及椎管减压。结果 5例均完成手术,未发生神经根损伤、硬膜囊撕裂、椎间隙感染等并发症。5例于术后即刻下肢疼痛均缓解,视觉模拟评分(Visual Analogue Scale,VAS)由术前(7.8±0.7)分降为(2.8±0.7)分。术后第3天复查MRI提示椎管及根管无明显受压。1例术后第5天椎间盘突出复发行二次内镜手术。5例随访6～24个月,平均12.4月。末次随访日本骨科学会(Japanese Orthpaedic Association,JOA)下腰痛评分为23.6±2.4,优4例,良1例。术后3个月下肢肌力2例由术前Ⅲ级恢复至Ⅳ级,3例由术前Ⅳ级恢复至Ⅴ级。鞍区及会阴部感觉2例于术后6个月、2例12个月恢复正常,1例术后15个月部分恢复,仍残留部分感觉异常。直肠膀胱功能方面:3例小便费力不尽感者于术后5～7个月恢复正常,1例尿潴留者术后1年仍需间断导尿,有大便不尽感且偶发肠胀气。结论脊柱内镜技术是治疗椎间盘源性马尾综合征的安全、有效的微创手术方法。

Objective To explore the clinical effects of percutaneous endoscopic lumbar discectomy（ PELD） for cauda equina syndrome（ CES） caused by lumbar disc herniation（ LDH）. Methods A total of 5 patients with CES caused by LDH who underwent PELD from October 2014 to December 2016 were selected as the objects of study. The number of patients with LDH segment of L5/S1,L（4/5）,and L（2/3） was 3,1,and 1,respectively. For the 5 patients,their root canal and spinal canal were decompressed with PELD. Results There were no complications of nerve root injury,dura mater laceration or intervertebral space infection. For the 5 patients,the pain of the lower limbs was relieved immediately after operation. The Visual Analogue Scale（ VAS） scores decreased from（ 7. 8 ± 0. 7） points to（ 2. 8 ± 0. 7） points. The MRI at 3 days after operation did not show any obvious compression on dura mater and nerve root. The second surgery was performed on a patient with recurrent disc herniation at 5 days after operation. All the patients were followed up for 6-24 months,with an average of 12. 4 months. The Japanese Orthpaedic Association（ JOA） scores of low back pain were increased from（ 6. 2 ± 0. 7） points at pre-operation to（ 23. 6 ± 2. 4） points at the last follow-up post-operation,showing 4 cases of excellent results and 1 case of good result. The muscle strength of the lower limbs was obviously restored at 3 months after operation. Among them,the muscle strength of 2 patients was improved from grade Ⅲ to Ⅳ and that of 3 patients was improved from grade Ⅳ to Ⅴ. In aspect of the feeling of saddle area and perineum,2 patients returned to normal at 6 months after operation,and 2 patients returned to normal at 12 months after operation. However,1 patient was back to normal partly at 15 months after operation. In terms of the urinary and bowel functions,3 patients with urinary insufficiency became normal at 5-7 months after operation. One patient with urinary retention needed intermittent catheterization,and incomplete defecation and occasional flatulence occurred at 1 year after operation. Conclusion PELD is a safe and effective minimally invasive surgical technique for the treatment of CES caused by disc herniation.