单侧双通道内镜下经椎板间入路治疗高度游离型椎间盘突出症

目的探讨单侧双通道内镜技术(UBE)下经椎板间入路治疗高度游离型椎间盘突出,并证明其临床安全性及疗效。方法2018年12月至2021年5月,共13例高度游离型椎间盘突出患者接受UBE经椎板间入路手术治疗,采用腰痛及腿痛的视觉模拟评分(VAS),腰椎Oswestry功能障碍指数(ODI)及改良MacNab标准评估手术疗效。结果其中L3/4节段1例(7.7%),L4/5节段患者10例(76.9%),L5/S1节段2例(15.4%);向上游离突出3例、向下游离突出10例;患者腿痛的VAS评分从术前为(7.85±1.29)改善到术后3个月为(2.55±1.52),术后1年为(1.84±1.08),差异有统计学意义(P<0.01);ODI评分从术前的(84.91±6.35)改善到术后3个月的(27.84±7.33),术后1年(17.55±13.39),差异有统计学意义(P<0.01);按照改良MacNab标准评定:优6例,良5例,可2例。结论UBE经椎板间入路治疗高度游离型LDH疗效满意,为临床治疗高度游离型LDH提供了一种新方法,有利于神经功能恢复,安全可靠。

Objective To describe in detail the technique of the treatment of extremely highly migrated lumbar disc herniation by translaminar approach in Unilateral Biportal Endoscopy(UBE)and to demonstrate the clinical results.Methods From December 2018 to May 2021,13 patients with extremely highly migrated Lumbar disc herniation(LDH)were treated with UBE by translaminar approach.The visual analogue scale(VAS)score,Oswestry disability index(ODI)and modified MacNab criteria were used to evaluate the outcome of surgery.Results The operated levels were L3/4 in 1(7.7%)patient,L4/5 in 10(76.9%),and L5-S1 in 2(15.4%).The directions of migration were cranial in 3 patients and caudal in 10.The mean VAS for leg pain improved from 7.86±1.28 preoperatively to 2.55±1.52 at 3 months postoperatively and 1.85±1.07 at 1 year postoperatively,with statistical significance(P<0.01).The mean preoperative ODI improved from 84.91±6.35 preoperatively to 27.84±7.33 at 3 months postoperatively and 17.55±13.39 at 1 year postoperatively,with statistical significance(P<0.01).According to modified MacNab criteria,excellent outcome was achieved in 6 cases,good in 5 and fair in 2.Conclusion The technique of the treatment of extremely highly migrated LDH by translaminar approach in UBE can be effective and safty.It provides a new method for the clinical treatment of extremely highly migrated LDH.