全可视化脊柱内镜辅助动力磨钻经椎板间入路治疗腰椎间盘突出症的近期疗效

The short-term effect of full visualization spinal endoscopy assisted dynamic drill through interlaminar approach in the treatment of lumbar disc herniation

目的研究全可视化脊柱内镜辅助动力磨钻经椎板间入路治疗腰椎间盘突出症的近期疗效。方法回顾性分析本院2019年6月~2020年12月收治的52例腰椎间盘突出症患者临床资料,L_(4-5)13例,L_(5)-S_(1)39例。采用全可视化脊柱内镜辅助镜下动力磨钻经椎板间入路行腰椎间盘髓核摘除术。分别于术前及术后3个月、6个月、12个月(或末次随访时)采用腰腿痛VAS评分及Oswestry功能障碍指数(Oswestry dysfunction index,ODI)及MacNab标准评价手术效果。结果52例均顺利完成手术。1例术中工作套管牵拉神经引起术后单侧下肢肌力下降,保守治疗6个月后改善;另1例术后出现责任节段以下双下肢麻木,保守治疗3个月后症状好转。手术时间90~240(151.54±37.58)min,住院时间6~7(6.75±0.437)d;随访时间13~28(21.21±5.035)个月。术后第3、6、12个月(或末次随访)时的腰腿痛VAS评分和ODI指数均显著优于术前,差异有统计学意义(P<0.05)。术后12个月(或末次随访)采用MacNab标准进行疗效评定:优40例,良6例,可4例,差2例,优良率88.46%(46/52)。结论全可视化脊柱内镜辅助动力磨钻经椎板间入路治疗腰椎间盘突出症,安全、有效、可行。

Objective To study the short-term effect of full visualization spinal endoscopy assisted dynamic drill through interlaminar approach in the treatment of lumbar disc herniation.Methods The clinical data of 52 patients with lumbar intervertebral disc herniation admitted in our hospital from June 2019 to December 2020 were retrospectively analyzed.Among them,13 cases were protruding segment L_(4-5)and 39 cases were L_(5)-S_(1).The lumbar intervertebral disc nucleus pulposus was performed with a dynamic drill through the interlaminar approach with full visualization spinal endoscopy.Visual analogue scale(VAS),Oswestry dysfunction index(ODI)and MacNab criteria were used to evaluate the effect of surgery before operation and 3,6 and 12 months after operation(or at the last follow-up).Results All 52 cases completed the operation successfully.In 1 case,the traction of the nerve by the working cannula caused a decrease in the muscle strength of the lower extremity after operation,which was improved after 6 months of conservative treatment.Another 1 case developed numbness of both lower limbs below the responsible segment after surgery,and the symptoms improved after 3 months of conservative treatment.The operation time was 900x0E䥺Symbol~A@0x0F240(151.54±37.58)min,the hospital stay was 60x0E䥺Symbol~A@0x0F7(6.75±0.437)d;the follow-up time was 130x0E䥺Symbol~A@0x0F28(21.21±5.035)months.The VAS score of low back and leg pain and ODI index at 3,6 and 12 months after operation(or the last follow-up)were significantly better than those before operation(P<0.05).After 12 months(or the last follow-up),the curative effect was evaluated by MacNab standard:excellent in 40 cases,good in 6 cases,fair in 4 cases,poor in 2 cases,and the excellent and good rate was 88.46%(46/52).Conclusion It is safe,effective and feasible to treat lumbar disc herniation with full visualization spinal endoscopy assisted dynamic drill through interlaminar approach.