单侧双通道脊柱内镜技术治疗椎间孔型腰椎间盘突出:一种基于椎间孔区三维解剖结构的通道设计和手术技术

Unilateral biportal endoscopy for intraforaminal lumbar disc herniation:a new channel design and surgical technique based on the three-dimensional anatomical structure of the intervertebral foramina

目的:通过脊柱单侧双通道内镜技术(UBE)治疗椎间孔型腰椎间盘突出(ILDH)的临床研究,设计了一种基于椎间孔区三维解剖结构的超远外侧入路(FFLB)并评价其临床应用价值。方法:回顾性分析2020年1月至2022年1月收治的12例ILDH患者的临床资料。男4例,女8例;年龄26~68岁,平均(46.5±11.8)岁;体重指数21.1~27.8 kg/m^(2),平均(25.04±1.94)kg/m2;记录手术时间、住院时间,对比分析手术前后的疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分、直腿抬高角度、MRI矢状位和轴位椎间孔距离。结果:所有患者手术顺利完成,手术时间40~90 min,平均(67±15)min。术后随访时间6~13个月,平均(7.5±2.2)个月。术后即刻、术后3个月和术后6个月的腰腿痛VAS评分均低于术前,JOA评分高于术前,差异有统计学意义(P<0.05);直腿抬高角度大于术前,差异有统计学意义(P<0.05);MRI轴位椎间孔内孔、正中央、外孔前后距离均大于术前,差异有统计学意义(P<0.05);MRI矢状位椎间孔上区和下区的椎间孔内孔、正中央、外孔前后距离均大于术前,差异有统计学意义(P<0.05)。结论:FFLB增加了操作器械的外展角,方便椎间孔内外操作。准确的初始定位和清晰的三维解剖结构为治疗ILDH提供了新选择。

Objective:To evaluate a new surgical approach and technique,far-far lateral biportal(FFLB)in the treatment of intraforaminal lumbar disc herniation by unilateral biportal endoscopy(UBE)based on the three-dimensional anatomical structure of the intervertebral foramina.Methods:Twelve patients with intraforaminal lumbar disc herniation who were treated from January 2020 to January 2022 were analyzed retrospectively in this study.There were 4 males and 8 females with a mean age of(46.5±11.8)years(range,26-68 years)and a mean body mass index(BMI)of(25.04±1.94)kg/m2(range,21.1-27.8 kg/m^(2)).The operation time and hospitalization time were recorded.Visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score,straight leg elevation angle,and foramen intervertebral distances in sagittal and axial MRI results were assessed.Results:The operation was performed successfully in all the patients.The mean operation duration was(67±15)min(range,40-90 min).All the patients were followed up for(7.5±2.2)months on average(range,6-13 months).Compared with preoperative ones,the VAS scores of low back and leg were significantly decreased,and JOA score and straight leg elevation angle were significantly increased immediately after surgery and 3 and 6 months postoperatively(P<0.05).Compared with preoperative ones,the space distance of the interior,middle and exterior of intervertebral foramen in axial MRI and the space distance between the superior and inferior region of the internal,middle and external foramen in sagittal MRI were significantly increased at discharge,and 3 and 6 months postoperatively(P<0.05).Conclusions:The increased abduction angle of FFLB is convenient for operation in the intervertebral foramen.Accurate location and clear three-dimensional anatomical structure of FFLB provide a new choice for the treatment of intraforaminal lumbar disc herniation.