侧入路单通道下经皮椎间孔镜手术治疗相邻双节段腰椎间盘突出症

Treatment of Adjacent Segmental LDH through Percutaneous Transforaminal Microsurgical Approach with Single Channel

目的研究侧入路单通道下经皮椎间孔镜手术治疗相邻双节段腰椎间盘突出症的临床疗效。方法自2016年2月-2018年7月收治36例相邻双节段腰椎间盘突出症患者,其中L 3-4合并L 4-515例,L 4-5合并L 5-S 121例,均采用侧入路单通道下经皮椎间孔镜手术行相邻双节段腰椎间盘突出症的髓核取出+椎管减压术。术后随访12~29个月,平均(16.26±2.12)个月,观察其手术疗效及术中术后并发症情况。结果36例患者均完成手术,平均耗时(75.37±15.28)min;经术后1个月、6个月和末次随访,患者的腰痛和下肢痛VAS评分及ODI评分均显著低于术前(P<0.05),手术优良率为94.44%;术后均无神经根永久性损伤、脏器及大血管损伤、硬脊膜撕裂、术后感染等并发症发生。结论侧入路单通道下经皮椎间孔镜手术治疗相邻双节段腰椎间盘突出症,能减少损伤,缩短手术时间,减少术中透视次数,显著改善患者腰腿疼痛症状及生活质量,不增加手术并发症,手术安全有效。

Objective To study the clinical effect of single-channel percutaneous transforaminal endoscopy through lateral approach in the treatment of adjacent lumbar disc herniation.Methods From February 2016 to July 2018,36 patients with bilateral lumbar disc herniation were treated,including L 3-4 with L 4-5 in 15 cases,L 4-5 with L 5-S 1 in 21 cases.All patients underwent single-channel percutaneous transforaminal endoscopic discectomy through lateral approach for nucleus pulposus extraction and spinal canal decompression in two-level lumbar disc herniation.The follow-up period ranged from 12 to 29 months,with an average of(16.26±2.12)months.The operative efficacy and complications were observed.Results All the 36 patients completed the operation with an average time of(75.37±15.28)minutes.After 1 month,6 months and the last follow-up,the VAS and ODI scores of low back pain and lower limb pain were significantly lower than those before operation(P<0.05),and the excellent and good rate of the operation was 94.44%.There were no permanent nerve root injury,organ and great vessel injury,dural spinal cord injury after the operation.Complications such as laceration and post-operative infection occurred.Conclusions Single-channel percutaneous transforaminal endoscopy via lateral approach for double-segment lumbar disc herniation can reduce injury,shorten operation time,reduce the number of intraoperative fluoroscopy,significantly improve the symptoms and quality of life of patients with lumbar and leg pain,without increasing surgical complications,and the operation is safe and effective.