经皮内镜辅助下经椎板间隙椎间融合治疗L_(5)S_(1)椎间盘突出症

Percutaneous endoscopic translaminar lumbar interbody fusion for the treatment of L_(5)S_(1) intervertebral disc herniation

目的:观察经皮内镜辅助下经椎板间隙腰椎椎间融合术(percutaneous endoscopic translaminar lumbar interbody fusion,PE-TLIF)治疗L_(5)S_(1)椎间盘突出症的有效性及安全性。方法:对2018年1月至2019年12月实施PE-TLIF治疗的37例L_(5)S_(1)椎间盘突出患者进行回顾性分析,其中男16例,女21例;年龄30~68(45.62±13.57)岁;体质量指数19.5~28.8(24.33±3.51)kg/m2;病程18~48(27.18±6.65)个月。记录手术时间、术中出血量、术后引流量以及并发症发生率;观察术前及术后1周、6个月、1年的视觉模拟评分(visual analogue scale,VAS),腰椎日本骨科协会(Japanese Orthopaedic Association,JOA)评分和Oswestry功能障碍指数(Oswestry Disability Index,ODI)。结果:37例患者手术时间为78~171(120.74±41.19)min;术中出血量为61~102(85.26±25.44)ml;术后引流量为35~98(40.75±12.17)ml。8例患者出现并发症,其中神经损伤2例,疼痛加重4例,内固定松动1例,椎间隙不融合1例。患者术后1周、6个月、1年VAS、JOA评分和ODI较术前均有明显改善(P<0.05)。结论:PE-TLIF治疗L_(5)S_(1)椎间盘突出症具有术中出血量少、创伤小、近期疗效满意等优点,可以有效改善患者症状,但在实际临床中并发症发生率较高,需严格把握手术适应证。

Objective:To observe the effeicacy and safety of percutaneous endoscopic translaminar lumbar interbody fusion(PE-TLIF)in the treatment of L_(5)S_(1)intervertebral disc herniation.Methods:The clinical data of 37 patients with L_(5)S_(1)intervertebral disc herniation underwent PE-TLIF from January 2018 to December 2019 were retrospectively analyzed.There were 16 males and 21 females,aged from 30 to 68 years old,with a mean of(45.62±13.57)years;body mass index was from 19.5 to 28.8 kg/m2,with a mean of(24.33±3.51)kg/m2;the course of disease was from 18 to 48 months,with a mean of(27.18±6.65)months.Operation time,intraoperative blood loss,postoperative drainage and complication rate were recorded;visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score and Oswestry Disability Index(ODI)before operation,1 week,6 months,1 year after operation were observed.Results:The operation time ranged from 78 to 171 min,with a mean of(120.74±41.19)min;intraoperative blood loss ranged from 61 to 102 ml,with a mean of(85.26±25.44)ml;and postoperative drainage ranged from 35 to 98 ml,with a mean of(40.75±12.17)ml.Complications occurred in 8 patients,including 2 cases of nerve injury,4 cases of pain aggravated,1 case of internal fixation loosening,and 1 case of intervertebral space nonfusion.The VAS,JOA score and ODI significantly improved after 1 week,6 months,and 1 year after operation(P<0.05).Conclusion:PE-TLIF for the treatment of L_(5)S_(1)intervertebral disc herniation has the advantages of less intraoperative blood loss,less trauma,and satisfactory short-term curative effect.It can effectively improve the symptoms of patients.However,the incidence of complications in the actual clinical practice is frequent,and surgical indications need to be strictly grasped.