椎间盘镜联合椎间孔镜治疗L5S1椎间盘突出症

MED instruments combined with PELD instruments for L5S1 disc herniation

[目的]介绍椎间盘镜联合椎间孔镜治疗L5 S1椎间盘突出症的手术技术和初步临床效果。[方法]选择2017年1月~2019年9月48例L5S1椎间盘突出症患者,采用先行MED入路,确定通道位于L5S1椎板交界处,咬除部分椎板进行开窗,切除部分黄韧带,形成约1.0 cm的开窗后,椎间盘镜下先置软组织1、2级扩张棒于椎间盘间隙,然后放置椎间孔镜工作通道,放入椎间孔镜,即可显示椎间盘组织及内侧的神经根和硬膜囊,然后旋转套管用套管尖端将硬膜囊及神经根隔离至内侧,并松动椎间盘镜通道,使椎间孔镜随神经根的走向探查并取出间盘组织,探查神经根活动良好后,离子刀修复纤维环撕裂口。[结果]所有患者均顺利手术,术中均未发生硬脊膜破裂及脑脊液漏,2例术后麻木症状加重,1个月后逐渐消失;1例术后疼痛加重,3 d症状消失。随访1~33个月,按Macnab标准,临床结果评定为优33例、良15例。[结论]MED联合PELD治疗L5/S1椎间盘突出症,结合两者优势,可得到良好的治疗效果。

[Objective]To introduce the surgical technique and primary clinical outcomes of micro endoscopic discectomy(MED)instruments combined with percutaneous endoscopic lumbar discectomy(PELD)instruments for L5 S1 disc herniation.[Methods]From January 2017 to September 2019,48 patients underwent MED combined with PELD for L5 S1 disc herniation.The working portal of the MED was created firstly to expose the interlaminar space of L5 S1.After removing partial lamina and ligament flavum to form a fenestra 1.0 cm in diameter,the No 1 and 2 soft tissue expansions were inserted to the intervertebral disc sequentially through the MED working channel,and then the PELD endoscope was placed to observe the dural sac,nerve root and intervertebral disc.The endoscopic tube was rotated to retract dural sac and nerve root to medial side and expose the herniated disc properly,then the herniated disc tissue was removed to release the nerves.After complete decompression achieved,the crack of annulus fibrosus was trimmed with a radiofrequency coblation.[Results]All the patients had surgical procedures performed smoothly without dural tear or spinal fluid leakage in any one of them.Three patient had worsened numbness,which subsided in 1 month,while1 patient got worsened pain,which relived in 3 days.At the end of follow up ranged from 1 to 33 months,the clinical outcomes were graded as excellent in 33 and good in 15 patients based on Macnab criteria.[Conclusion]MED instrument combined with PELD instrument take advantages of both,and achieves satisfactory clinical outcomes for L5S1 disc herniation.