经椎板间入路保留黄韧带脊柱内镜手术治疗L_(5)S_(1)椎间盘突出症的疗效观察

Efficacy of spinal endoscopic surgery with ligamentum flavum preservation through interlaminar approach for L_(5)S_(1)intervertebral disc herniation

目的观察经椎板间入路保留黄韧带脊柱内镜手术治疗L_(5)S_(1)椎间盘突出症的临床疗效,总结手术操作经验。方法回顾性分析自2016-03—2021-03采用经椎板间入路脊柱内镜手术治疗的26例L_(5)S_(1)椎间盘突出症,术中在保留黄韧带的基础上进行脊柱内镜操作。比较术前、术后第2天、术后1个月腰痛NRS评分、腿痛NRS评分、ODI指数。术后6个月根据改良MacNab标准评价疗效。结果26例均获得随访,随访时间6~14个月,平均12个月。术后切口均一期愈合,无神经根损伤、脑脊液漏、血肿、感染等并发症发生。术后第2天腰痛NRS评分、腿痛NRS评分、ODI指数较术前明显改善,术后1个月上述指标较术后第2天持续改善,差异有统计学意义(P<0.05)。术后6个月根据改良MacNab标准评价疗效:优21例,良3例,可2例。1例术后6个月复发,1例术后7个月复发,均行内固定融合术治疗。结论经椎板间入路保留黄韧带脊柱内镜手术治疗L_(5)S_(1)椎间盘突出症是一种微创和安全的手术方式,在严格把握手术适应证的同时还需要术者掌握脊柱开放手术和内镜手术操作经验。

Objective To observe the clinical effect of spinal endoscopic surgery with ligamentum flavum preservation throughinterlaminar approach for the treatment of L_(5)S_(1)disc herniation,and summarize the operative experience.Methods A retro-spective analysis was conducted on 26 patients with L_(5)S_(1)disc herniation treated with endoscopic discectomy via interlaminar ap-proach from March 2016 to March 2021.The spinal endoscopic procedures were performed on the basis of preserving the liga-mentum flavum.NRS score of low back pain,NRS score of leg pain and ODI index were compared before operation,2 days and1 month after operation.The curative effect was evaluated according to Modified Macnab Standard 6 months after operation.Results All 26 cases were followed up.The follow-up period ranged from 6 to 14 months(mean,12 months).All the incisionshealed in one stage without any complications such as nerve root injury,cerebrospinal fluid leakage,hematoma and infection.The NRS score of low back pain,NRS score of leg pain and ODI index were significantly improved on the 2nd day after opera-tion.The above-mentioned indexes were improved continuously 1 month after operation compared with 2 days after operation(P<0.05).According to the modified Mac Nab standard,21 cases were excellent,3 cases good and 2 cases fair.One case recurred 6months after operation,and the other one recurred 7 months after operation.All cases were treated with internal fixation and fu-sion.Conclusion Endoscopic surgery with ligamentum flavum preservation via interlaminar approach is a minimally invasiveand safe procedure for the treatment of L_(5)S_(1)disc herniation.It is necessary for the operator to master the operative experience ofspinal open surgery and endoscopic surgery while grasping the operative indication strictly.