经皮内镜经椎间孔椎间盘切除术治疗L5/S1椎间盘突出症的效果及术中穿刺困难发生情况

Percutaneous endoscopic transforaminal discectomy for L5/S1 lumbar disc herniation:efficacy and occurrence of intraoperative difficulty in puncture

目的 探讨经皮内镜经椎间孔椎间盘切除术(PETD)治疗L5/S1椎间盘突出症的效果,并分析术中穿刺困难的发生情况及原因。方法纳入84例L5/S1节段椎间盘突出患者,均采用PETD治疗。比较手术前、术后7d及术后1个月腰腿痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)。记录术中穿刺困难的发生情况,并分析原因及解决方案。结果患者VAS评分及ODI均随时间的延长而降低(均P<0.05)。术中出现穿刺困难5例,其中遇到髂骨遮挡4例,遇到横突遮挡1例。结论PETD治疗L5/S1椎间盘突出症可获得良好疗效,但术中有可能出现穿刺失败,而髂骨及横突的遮挡可能是造成手术穿刺困难的原因。

Objective To investigate the efficacy of percutaneous endoscopic transforaminal discectomy(PETD) for L 5/S 1 lumbar disc herniation,and to analyze occurrence and causes of intraoperative difficulty in puncture. Methods Eighty-four patients with segment L 5/S 1 lumbar disc herniation were recruited,and all underwent PETD.The preoperative,postoperative 7-day and 1-month Visual Analogue Scale(VAS) scores for pain in lower extremities and waist were compared,so did the Oswestry disability index(ODI). The incidence of intraoperative difficulty in puncture was recorded,and the causes and solution were analyzed. Results Patients′ VAS score and ODI decreased over time(all P <0.05).Five cases had difficulty in puncture,including 4 occluded by ilium and 1 by processus transversus. Conclusion PETD achieves favorable efficacy for L 5/S 1 lumbar disc herniation,however,failure in puncture probably occurs during operation,and occlusion by ilium or processus transverses might result in difficulty in puncture during operation.