全内镜下椎板间隙入路治疗腰5骶1椎间盘突出症  

Full-endoscopic interlaminar approach to surgical treatment of lumbar disc herniation

作　　者：徐海栋[1] 付强[2] 许斌[1] 赵建宁[1] 刘刚[1] 

机构地区：[1]第二军医大学南京临床医学院(南京军区南京总医院)骨科,南京医学博士研究生210002 [2]第二军医大学附属长海医院骨科,上海200433

出　　处：《医学研究生学报》2013年第9期959-962,共4页Journal of Medical Postgraduates

摘　　要：目的全内镜下经椎板间入路手术治疗腰椎间盘突出症是近年来新兴起来的脊柱微创手术技术,该技术较以往具有视野清楚、解剖路径熟悉、损伤小的优点。文中评估采用全内镜下椎板间隙入路行腰5骶1椎间盘突出症治疗的临床疗效及安全性。方法 2009年9月至2011年9月在全内镜下经椎板间隙入路治疗的单节段腰5骶1椎间盘突出症患者20例为全内镜下微创手术组,并用随机数字法选择同期后路小切口开放椎间盘手术治疗患者20例作为对照组。对2组患者的手术时间、术中出血量、平均住院日、手术中去除的骨与韧带组织质量、并发症发生情况等围手术期指数进行对比分析。采用ODI(Oswestry disability index)指数以及腰腿痛VAS评分评定临床疗效。结果患者均获得1年以上的随访观察。平均手术时间、并发症发生率2组差异无统计学意义(P>0.05);术中出血量、平均住院日、手术中去除的骨与韧带组织质量内镜下微创手术组具有明显的优势(P<0.05)。在临床疗效评估方面,2组患者术后3个月、1年随访时ODI、VAS疗效评估指标与术前相比均有显著改善(P<0.05),而术后3个月、1年随访时ODI、VAS评估指标内镜下微创手术组明显优于对照组(P<0.05)。结论与常规小切口开放手术相比,全内镜下椎板间隙入路治疗腰椎间盘突出症临床疗效肯定,具有微创、早期修复重建、功能保护较好的优势。Objective The full-endoscopic interlaminar approach to surgical treatment of lumbar disc herniation （LDH） is a new technique of minimally invasive surgery, with the advantages of clear vision, familiar anatomical path and minimal damage. The purpose of this study was to evaluate the clinical effect and safety of full-endoscopic discectomy via interlaminar approach in the treat- ment of LDH. Methods Twenty patients with L5S1 lumbar disc herniation underwent full-endoscopic minimally invasive surgery （FE group） and another 20 received posterior small-incision open discectomy （control group）. We compared the peri-operative param- eters, such as operation time, bleeding volume, length of hospital stay, quality of removed bone and ligament and post-operative com- plications, between the groups. We evaluated the clinical effectiveness using the Oswestry Disability Index （ODI） and Visual Analogue Scale （VAS）. Results All the patients were followed up for 12 months or longer. No statistically significant differences were found between the two groups in the mean operation time and complications （ P 〉 0.05 ）. The FE group showed obviously more advantages o- ver the control group in the intra-operative bleeding volume, length of hospital stay and quality of removed bone and ligament （ P 〈 0.05 ）. At 3 and 12 months after surgery, ODI and VAS were significantly improved in both the FE and control groups （P 〈 0.05 ）, even more significantly in the former than in the latter （ P 〈 O. 05 ）. Conclusion Compared with posterior small-incision open dis- cectomy, full-endoscopic minimally invasive surgery has a more definite curative effect on LDH, with the advantages of minimal inva- siveness, early restoration, and function protection.

关 键 词：椎间盘移位 内镜治疗 椎间盘切除术 微创手术 临床疗效 

分 类 号：R681.53[医药卫生—骨科学]