经椎板间内镜联合纤维环缝合修复术治疗巨大型腰5/骶1椎间盘突出症的临床疗效分析

Clinical efficacy of percutaneous endoscopic interlaminar discectomy plus suture repair of annulus fibrosus as a treatment of giant L5/S1 disc herniation

目的:分析经椎板间隙入路内镜微创手术联合纤维环缝合修复治疗巨大型腰5/骶1椎间盘突出症的临床疗效。方法:选择分型属于巨大型腰5/骶1椎间盘突出症,且经严格保守治疗无效的患者21例,采用气管插管全麻下经椎板间隙入路内镜下腰5/骶1椎间盘髓核摘除、椎管扩大减压、神经松解、等离子消融术,联合纤维环缝合缝合修复术。于术前、术后1天、术后1月、术后3月、术后6月及术后1年采用疼痛视觉模拟评分(VAS)评估患者腰痛及腿部疼痛的情况、采用Oswestry功能障碍指数(ODI)评估患者腰椎功能的恢复情况。末次随访时采用改良的MacNab标准评价临床疗效。术后第2天及术后3月复查腰椎MRI了解髓核摘除及椎间盘恢复情况。结果:全部患者均顺利完成内镜下手术,无中转开放手术,手术时间(62.5±11.7)min。术后所有患者均获得随访,随访时间(11.3±3.5)个月。ODI指数由术前平均52.71%±13.82%下降至末次随访时3.25%±2.76%,差异有统计学意义(P<0.05),术后腰椎功能得到明显恢复;VAS评分由术前平均(8.51±1.17)分下降至末次随访时(1.02±0.72)分,差异有统计学意义(P<0.05);末次随访时评定手术疗效,其中优18例、良2例、可1例,优良率为95.24%。随访期内无腰椎间盘突出复发,术中及术后均未发现神经根损伤、硬脊膜损伤等严重并发症。结论:经椎板间隙入路内镜微创手术联合纤维环缝合修复治疗巨大型腰5/骶1椎间盘突出症的临床疗效确切,具有损伤小、术后恢复快、并发症低等优点,短期随访未见复发。

Objective:To investigate the clinical efficacy of percutaneous endoscopic interlaminar discectomy plus suture repair of annulus fibrosus via the interlaminar approach for treatment of giant L5/S1 disc herniation.Methods:Included in this study were 21 patients with giant L5/S1 disc herniation who failed rigorous conservative treatment.Under general anesthesia with tracheal intubation,the subjects underwent endoscopic removal of nucleus pulposus,enlargement and decompression of the spinal canal,neurolysis and plasma ablation via the interlaminar approach,combined with suture repair of the annulus fibrosus.Pain visual analogue(VAS)scale was used to assess the low back pain and leg pain before surgery and at 1 day,1,3 and 6 months,and 1 year after surgery.Oswestry Disability Index(ODI)was used to evaluate the function recovery of lumbar spine in the patients.Modified MacNab criteria were used to evaluate the clinical efficacy on the last follow-up.At 2 days and 3 months after surgery,repeat lumbar spine MRI was used to examine the removal of nucleus pulposus and recovery of the intervertebral disc.Results:All patients underwent the endoscopic surgery successfully with no conversion to open surgery.The operation time was(62.5±11.7)min.All patients were followed up after surgery for(11.3±3.5)months.The ODI decreased from a mean of 52.71%±13.82%before surgery to 3.25%±2.76%on the lastfollow-up,with statistically significant difference(P<0.05).In all patients,the lumbar spine function recovered significantly after surgery.The VAS score decreased from a mean of(8.51±1.17)points before surgery to(1.02±0.72)points on the last follow-up,with statistically significant difference(P<0.05).The surgical efficacy evaluated on the last follow-up was excellent in 18,good in 2,and fair in 1 case,corresponding to a rate of excellent and good response in 95.24%of all patients.During the follow-up,there was no relapse of lumbar disc herniation,and no serious complications such as injury to the nerve roots or dural were found during and after surgery.Conclusion:Minimally-invasive percutaneous endoscopic interlaminar discectomy plus suture repair of annulus fibrosus via the interlaminar approach offers definite clinical efficacy for treatment of giant L5/S1 disc herniation,with advantages in minimal trauma,quick recovery after surgery,and fewer complications.No relapse was seen during the short-term follow-up.