经椎板间入路椎间孔镜治疗L_5-S_1向下脱垂型腰椎间盘突出症36例

36 Cases of L5-S1 Downward Prolapsed Lumbar Disc Herniation Treatment with Intervertebral Foramen by Translaminar Approach

目的:观察经椎板间入路椎间孔镜治疗L5-S1向下脱垂型腰椎间盘突出症的临床疗效。方法:收集2014年5月—2017年6月江西省中医院脊柱骨科收治的诊断为L5-S1向下脱垂型腰椎间盘突出症患者36例,行椎板间入路椎间孔镜髓核摘除术,记录患者手术大致出血量、手术时间、术中透视次数、术后并发症、术前及术后的视觉疼痛模拟评分(VAS)、Oswestry腰部功能障碍指数(ODI)等为评判指标进行临床观察。结果:平均手术时间为128. 5 min。术后短期小腿后方麻木加重2例,经脱水消肿治疗后1周症状缓解;腰骶神经根牵拉损伤1例,经营养神经治疗后2个月症状缓解;脱出髓核摘除不彻底1例,采用开放手术治疗。平均随访时间6. 3个月,术后腰腿痛VAS评分较术前明显改善(P <0. 05),术后3个月ODI指数较术前明显改善(P <0. 05),随访期内无复发。结论:经椎板间入路椎间孔镜治疗向下脱垂型腰椎间盘突出症可获得良好的临床疗效,其中治疗的技术关键点在于使用三维结构镜准确判断髓核脱出情况。

Objective ： To observe the clinical efficacy of interverlebral foramen by translaminar approach in the treatment of L5/S1 prolapsed lumbar disc herniation. Methods： 36 eases of lumbar intervertebral disc prolapse diagnosed as L5/S1 downward prolapse of lumbar intervertebral disc herniation were collected from the Departmnt of orthopedics of the spinal eolunm of Jiangxi traditional Chinese medicine hospital in June 2014 - 2017, and intervertebral lamellar nucleus pulposeetomy was performed by intervertebral endoscopy. To record the general bleeding volume, operation time, intraoperative fluoroscopy number, postoperative complications, preoperative and postoperative visual pain simulation score （VAS）, and Oswestry lumbar dysfunction index （ODI） as clinical observation index. Results：The average operation time was 128.5 min. After operation, there were 2 eases of short leg posterior numbness and 1 ease of nerve root traction injury. The symptoms disappeared in February, 1 ease was removed from the nucleus pulposus, and the operation was turned to open. The average follow - up time was 6.3 months. The VAS score of lumbago and leg pain was better than that before operation （ P 〈 0.05 ）, and the index index of Oswestry dysfunction was improved at 3 months after operation （ P 〈 0.05 ）, and no recurrence was found during the follow -up period. Conclusion： Intervertebral endoscopy for prolapse of prolapse of the prolapse of the lumbar intervertebral disc can achieve a good clinical effect. The key point of the treatment is to use a three - dimensional structural mirror to accurately determine the occurrence of nucleus pulposus.