经椎板间入路椎间孔镜下治疗巨大腰椎间盘突出症的疗效观察  

Observation on clinical outcome of discectomy through interlaminar access by transforaminal endoscope in treating massive lumbar disc herniation

作　　者：芮钢[1] 林圣荣 孙乃坤[1] 冯进益[1] 胡宝山[1] 

机构地区：[1]厦门大学附属第一医院骨科,福建361003

出　　处：《中国骨与关节杂志》2016年第5期367-370,共4页Chinese Journal of Bone and Joint

基　　金：厦门市科技局基金(3502Z20154002)

摘　　要：目的评估经椎板间入路椎间孔镜下治疗巨大腰椎间盘突出症手术的有效性及其安全性。方法 2008年3月至2015年12月,我院采用后入路经椎板间入路治疗102例腰椎间盘突出症患者,其中男56例,女46例,年龄17-65岁,平均35岁。2名骨科医师对腰椎间盘突出患者术前MRI影像独立进行分析,确认腰椎间盘椎管侵占率〉50%者,评估为巨大腰椎间盘突出,行经椎板间入路椎间孔镜下髓核摘除术治疗,术后进行MRI或者CT复查,和术前影像进行对比观察硬膜囊、神经根受压情况,对患者术前、术后1天、3个月进行视觉模拟评分（visual analogue scale,VAS）,并进行统计学分析,术后3个月进行Mac Nab评分,评价经椎板间入路治疗巨大腰椎间盘突出症手术的安全性和有效性。结果所有患者均顺利完成手术,手术时间平均每个节段60 min,术中出血量平均15 ml,术中无并发症发生。术后复查MRI或CT显示突出椎间盘髓核被切除,硬膜囊、神经根未再受压。术后1天、3个月的VAS评分分别为（1.9±1.0）分、（1.8±1.4）分,均较术前（6.5±2.5）分明显降低,差异有统计学意义（P〈0.01）。术后3个月时按照Mac Nab标准评定,优64例,良34例,可3例,差1例,优良率为96.1%。结论经椎板间入路椎间孔镜下治疗巨大腰椎间盘突出症疗效肯定,可很好地解决患者临床症状,安全有效。Objective To evaluate the clinical outcome and safety of discectomy through interlaminar access by transforaminal endoscopy in treating massive lumbar disc herniation. Methods The preoperative and postoperative MRI and CT data of patients with lumbar disc herniation were evaluated by 2 researchers independently. Before surgery, the patients with lumbar canal encroachment ratio 〉 50% were diagnosed as massive lumbar disc herniation and underwent discectomy through interlaminar access by transforaminal endoscope. Preoperative and postoperative radiological and clinical parameters including the compression degree of dural sac or nerve root, visual analogue scale （ VAS ） of low back pain and MacNab score were compared to evaluate the curative effect and safety of this surgery. Results All the surgeries were successful with the mean operation time of 60 minutes per segment, mean blood loss of 15 ml without complications. After surgery, the herniated disc of all patients was removed with dural sac or nerve root being decompressed completely according to MRI and CT. The VAS at first day and 3 months after surgery both decreased significantly compared with preoperative values （ P 〈 0.01 ）. The numbers of patients who were evaluated as excellent, good, fair and poor at 3 months after surgery were 64, 34, 3 and 1 respectively and the final rate of curative effect reached 96.1% according to MacNab score. Conclusions Discectomy through interlaminar access by transforaminal endoscope is safe and can obtain favorable clinical outcome in treating massive lumbar disc herniation.

关 键 词：外科手术 微创性 内窥镜 腰椎 椎间盘移位 

分 类 号：R687.3[医药卫生—骨科学]