经皮椎间孔镜下髓核摘除术治疗L4/5及L5/S1腰椎间盘突出症临床观察

Clinical Observation about Treatment of L4/5 and L5/S1 Lumbar Disc Herniation with Percutaneous Endoscopic Nucleus Pulposus Excision

目的:探讨后正中入路椎板开窗髓核摘除术与经皮椎间孔镜下髓核摘除术治疗L4/5及L5/S1腰椎间盘突出症的疗效比较。方法:将2015年至2017年间,在宁国市人民医院就诊的分别采用后正中入路椎板开窗髓核摘除术和经皮椎间孔镜下髓核摘除术两种方法治疗38例腰椎间盘突出症患者,其中32例获随访,男18例,女14例,年龄29~72岁,平均50.65岁。其中孔镜组15例,后路开窗组17例。比较手术时间、切口长度、术中出血及术前、术后JOA评分,对两组患者的手术疗效进行评价。结果:32例患者获随访,孔镜组与开窗组的手术时间分别为(89.67±15.75)min、(85.29±10.23)min,两组比较差异无统计学意义;切口大小分别为(1.21±0.16)cm、(5.66±0.25)cm,两组比较差异有统计学意义;术中出血分别为(29.33±9.80)ml、(150.59±19.19)ml,两组比较差异有统计学意义;术前JOA评分分别为(7.73±1.16)、(7.71±1.21),两组比较差异无统计学意义;术后JOA评分分别为(25.87±1.41)、(25.76±1.30),两组比较差异无统计学意义。结论:对于L4/5、L5/S1腰椎间盘突出症患者,通过恰当的病例纳入排除标准,微创椎间孔镜下髓核摘除术可以达到与后路开放手术同样的手术效果,同时椎间孔镜具有切口小,出血少等优点,术后恢复快,是L4/5、L5/S1腰椎间盘突出症的较为理想的治疗方式。

Objective:To explore the therapeutic effect of posterior midpoint lumbar intervertebral discherniation and the treatment of L4/5 and L5/S1 lumbar intervertebral disc herniation.Methods:From 2015 to 2017,in Ningguo City People’s Hospital after the middle of the road were used respectively to lamina windowing of nucleus pulposus with excision and percutaneous intervertebral foramen microscopically two methods of the extraction of nucleus pulposus in the treatment of 38 cases of patients with lumbar disc prolapse,including 32 cases received follow-up,18 were male,female 14 cases,aged 29-72,an average of 50.65 years old.Among them,there were 15 cases in the aperture group and 17 in the rear window group.The operative time,incision length,intra operative hemorrhage,preoperative and postoperative JOA scoring were compared to evaluate the surgical efficacy of the two groups.Results:32 patients were followed up,and the operation time of the aperture group and the open window group was respectively(89.67±15.75)minutes and(85.29±10.23)minutes.The difference between the two groups was not statistically significant.The incision size was(1.21±0.16)cm and(5.66±0.25)cm,and the difference between the two groups was statistically significant.Intraoperative hemorrhage was(29.33±9.80)ml,(150.59±19.19)ml,and the differences between the two groups were statistically significant.The preoperative JOA scores were(7.73±1.16)and(7.71±1.21),and the differences between the two groups were not statistically significant.Postoperative JOA scores were(25.87±1.41)and(25.76±1.30).The differences between the two groups were not statistically significant.Conclusion:For L4/5 patients,and L5/S1 lumbar intervertebral disc protrusion,through appropriate cases into the exclusion criteria,minimally invasive intervertebral foramen mirror can achieve the extraction of nucleus pulposus and posterior open surgery under the same operation effect,intervertebral foramen mirror with small incision at the same time,the advantage such as less bleeding,quicker recovery,is L4/5 and L5/S1 to the ideal treatment of lumbar disc prolapse.