改良经椎间孔入路全镜下L_(5)S_(1)减压术

Modified transforaminal approach for full endoscopic L_(5)S_(1) decompression

[目的]介绍改良经椎间孔入路全镜下椎间孔镜治疗L_(5)S_(1)椎间孔狭窄症的手术技术和初步临床效果。[方法]对12例L_(5)S_(1)椎间孔狭窄症患者,行经改良椎间孔入路全镜下椎间孔镜手术。透视下取经患侧L_(5)S_(1)椎间孔水平线为穿刺路径,水平线与髂骨嵴交点内侧作为穿刺进针点,穿刺至L_(5)峡部与S_(1)上关节突交界处外侧,置入套筒,全可视镜外环锯切除L_(5)部分峡部及S_(1)上关节突尖部少部分,去除压迫L_(5)神经根的突出髓核、肥厚黄韧带或钙化黄韧带,从而完成L_(5)神经根减压。[结果]所有患者均顺利完成手术,其中1例出现神经根外膜撕裂,另1例出现术后臀部疼痛,但都无严重不良后果。随访6个月~5年,平均(2.5±0.3)年,患者疼痛症状和功能均显著改善,无复发或症状加重。术后腰椎MRI显示所有患者L_(5)出口根均减压充分。[结论]改良经椎间孔入路全镜下椎间孔镜治疗L_(5)S_(1)椎间孔狭窄症具有可重复性强,不受高髂嵴限制,不影响脊柱稳定性等优点。

[Objective]To introduce the surgical technique and preliminary clinical results of modified transforaminal approach for full endoscopic L_(5)S_(1) decompression of foraminal stenosis.[Methods]A total of 12 patients with L_(5)S_(1) foraminal stenosis were treated by modified foraminal approach with full endoscopic L_(5)S_(1) decompression of foraminal stenosis.The horizontal line of the intervertebral foramina L_(5)S_(1) on the affected side was taken as the puncture path,while the inside of the intersection of the horizontal line and the crest of the iliac crest was used as the puncture needle point.The puncture was carried out to the outside of the junction between the isthmus of L_(5) and the apex of the superior articular process of S_(1),and then the cannula was inserted,and the isthmus of L_(5) and a small part of the apex of the superior articular process of S_(1) were removed with an external circular saw under the all-visual endoscope.The protruding nucleus pulposus,hypertrophic ligamentum flavum,or calcified ligamentum flavum pressing on the L_(5) nerve root were removed to complete decompression of the L_(5) nerve root.[Results]All the patients had operation performed smoothly and got significant improvement in terms of symptoms and function,except 1 who had a tear of the outer nerve root membrane and another had postoperative hip pain,both of them had no serious adverse consequences.During the follow-up period lasted for 6 months to 5 years,no recurrence or worsening of symptoms was found in anyone of them.[Conclusion]Modified transforaminal approach full endoscopic decompression for the treatment of L_(5)S_(1) foraminal stenosis has the advantages of strong repeatability,no restriction of high iliac crest,and no impact on spinal stability.