椎板间入路经皮内窥镜下翻修手术治疗L5-S1节段复发性腰椎间盘突出症

Treatment of recurrent lumbar disc herniation in L5-S1 segment by percutaneous endoscopic revision surgery with interlaminar approach

目的探讨经皮内镜椎板间入路腰椎间盘切除术(percutaneous endoscopic interlaminar discectomy,PEID)治疗L5-S1节段复发性腰椎间盘突出症的手术疗效。方法自2016年8月-2018年8月收治21例L5-S1节段LDH术后复发患者,其中男13例,女8例;年龄29-53岁,平均46.2岁;均予以PEID翻修手术治疗。初次手术方式为后路开窗髓核摘除术;初次手术至本次PEID手术的间隔时间为6-31个月,平均23.5个月。术后随访1年以上,分别在术后3 d、1个月、3个月、6个月和12个月进行腰痛、腿痛VAS评分和ODI指数评价,采用改良MacNab标准评价其总体疗效。结果21例中,19例患者均按原计划顺利完成PEID翻修手术,术中无硬膜撕裂、神经根刺激或损伤等并发症;另2例为腋下型突出,因硬膜与黄韧带严重粘连,术中分离时不慎引起硬膜囊撕裂,遂改行开放手术。19例完成PEID翻修者手术时间为39-62 min,平均(48.3±7.9)min;术后住院时间为3-5 d,平均(3.9±0.8)d。术后随访时间为13-27个月、平均(19.2±5.1)个月。随着术后随访时间的延长,患者腰痛、腿痛VAS和ODI指数均呈明显下降趋势,较术前差异有统计学意义(P<0.05)。术后12个月参照改良的MacNab标准:19例中,优9例,良7例,可2例,差1例,总优良率为84.2%。结论PEID手术治疗L5-S1节段复发性LDH可取得较好疗效,其切口小、术中创伤少、安全性高,可显著减轻腰腿疼痛、改善腰部功能障碍。

Objective To investigate the effect of percutaneous endoscopic interlaminar discectomy(PEID)in the treatment of recurrent lumbar disc herniation(LDH)at L5-S1 level.Methods From August 2016 to August 2018,21 patients with postoperative recurrence of L5-S1 LDH,including 13 males and 8 females,aged 29-53 years with an average of 46.2 years,were treated with PEID.The first operation was posterior fenestration,and the interval between the first operation and PEID operation was 6-31 months,with an average of 23.5 months.The patients were followed up for more than one year.The VAS score of low back pain,VAS score of leg pain and ODI index were evaluated at 3 days,1 month,3 months,6 months and 12 months after operation,respectively.The overall efficacy was evaluated by modified MacNab standard.Results Of the 21 cases,19 patients successfully completed the PEID revision operation according to the original plan,and there were no complications such as dural tear,nerve root stimulation or injury during operation.The other 2 patients were axillary type protrusion,because of the severe adhesion between dural and ligamentum flavum,the dural sac tear was caused by careless separation during operation,so they changed to open surgery.The operation time of 19 patients who completed PEID revision was 39-62 minutes,with an average of(48.3±7.9)min;the postoperative hospital stay was 3-5 days,with an average of(3.9±0.8)d.The postoperative follow-up time was 13-27 months,with an average of(19.2±5.1)months.With the extension of postoperative follow-up time,the VAS and ODI index of lumbago and leg pain in patients showed a significant downward trend,and the differences were statistically significant compared with before operation(P<0.05).At 12 months after operation,according to the modified MacNab standard,among 19 cases,there were excellent in 9 cases,good in 7 cases,fair in 2 cases,and poor in 1 case.The total excellent and good rate was 84.2%.Conclusion PEID operation can achieve a better effect in the treatment of recurrent LDH of L5-S1 segment,which has small incision,less trauma and high safety,and can significantly reduce the pain in the waist and legs and improve the lumbar dysfunction.