单切口经椎间孔入路全内镜下治疗双间隙腰椎间盘突出症

Endoscopic Lumbar Discectomy via Single Incision Transforaminal Approach for Double-segment Lumbar Disc Herniation

目的探讨单切口经椎间孔入路全内镜下治疗双间隙腰椎间盘突出症的临床疗效。方法2016年10月~2019年2月,对32例双间隙腰椎间盘突出症采用单切口经椎间孔入路全内镜下髓核摘除术,采用下肢痛视觉模拟评分(Visual Analogue Scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)评分、Oswestry功能障碍指数(Oswestry Disability Index,ODI)和改良MacNab标准评价疗效。结果32例术后随访10~36个月,平均14.8月。术前、术后3个月及末次随访下肢痛VAS评分分别为(7.2±1.2)分、(1.4±0.8)分、(1.6±0.9)分,JOA评分分别为(18.2±4.2)分、(27.2±1.4)分、(27.6±1.3)分,ODI分别为(50.4±10.2)%、(11.6±3.9)%、(10.5±3.8)%,术后及末次随访较术前均明显改善(P<0.05)。改良MacNab疗效评定标准:优15例,良13例,可3例,差1例,优良率87.5%(28/32)。结论单切口经椎间孔入路全内镜下治疗双间隙腰椎间盘突出症安全有效。

Objective To discuss the clinical efficacy of double-segment lumbar disc herniation by endoscopic lumbar discectomy via transforaminal approach.Methods From October 2016 to February 2019,a total of 32 cases diagnosed with double-segment lumbar disc herniation were treated with single incision transforaminal endoscopic lumbar discectomy via transforaminal approach.The lower limbs pain Visual Analogue Scale(VAS),Japanese Orthopedic Association(JOA)score,Oswestry Disability Index(ODI)and modified MacNab criteria were used to evaluate the efficacy.Results All the cases were followed up for 10-36 months,with an average of 14.8 months.At preoperation,3 months after operation and last follow-up,the lower limbs pain VAS scores were(7.2±1.2),(1.4±0.8)and(1.6±0.9)points,the JOA scores were(18.2±4.2),(27.2±1.4)and(27.6±1.3)points,and the ODI were(50.4±10.2)%,(11.6±3.9)%and(10.5±3.8)%,respectively.The postoperative and last follow-up results were significantly improved as compared with preoperation(P<0.05).According to the modified MacNab criteria,there were excellent in 15 cases,good in 13 cases,fair in 3 cases,and poor in 1 case.The excellent and good rate was 87.5%(28/32).Conclusion Single transforaminal endoscopic lumbar discectomy via transforaminal approach for the treatment of double-segment lumbar disc herniation under full endoscopy is safe and effective.