全内镜下腰椎纤维环缝合术的技术要点及临床疗效分析  

Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture

作　　者：李振宙[1] 曹峥[1] 赵宏亮 商卫林[1] 侯树勋[1] LI Zhen-zhou;CAO Zheng;ZHAO Hong-liang;SHANG Wei-lin;HOU Shu-xun(Department of Orthopaedics,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心骨科,北京100048

出　　处：《中国骨伤》2020年第6期498-504,共7页China Journal of Orthopaedics and Traumatology

摘　　要：目的:介绍全内镜下腰椎纤维环缝合术的技术要点,分析全内镜下腰椎间盘摘除、纤维环缝合术的临床疗效。方法:纳入2018年1月至2018年11月采用全内镜下腰椎间盘摘除、纤维环缝合术治疗的50例非包含型腰椎间盘突出症患者,根据病变节段选择经椎间孔入路全内镜下单针缝合术或经椎板间隙入路双针缝合术。术后第2天、3个月分别复查腰椎MRI及CT以评估突出椎间盘组织摘除的彻底性及神经减压的充分性。分别于术后第2天及3、6、12个月采用视觉模拟评分(visual analogue scale,VAS,100分制)评估患者疼痛症状缓解情况,于术后3、6、12个月采用Oswestry功能障碍指数(Oswestry Disability Index,ODI)评价患者腰椎功能恢复情况,术后1年随访时采用Macnab评定标准评估腰椎功能,记录神经根功能(感觉、肌力及反射)恢复状况。结果:所有手术顺利完成,采用经椎间孔入路27例(包括L3,48例、L4,519例),经椎板间隙入路23例(包括L4,511例、L5S112例)。手术时间平均43.2 min。无手术并发症发生,无腰椎间盘突出复发。所有患者术后腰椎MRI及CT检查显示突出椎间盘摘除完全、神经减压充分,无突出物残留。所有患者术后腰痛、下肢放射痛明显缓解,ODI评分明显改善(P<0.01)。术后1年随访时采用Macnab评定标准评估疗效,结果优17例,良29例,可4例。术后1年时受损神经根感觉、肌力明显恢复(P<0.01),但腱反射无明显恢复(P>0.05)。结论:全内镜下腰椎间盘摘除、纤维环缝合术是安全、有效的微创脊柱外科手术技术,能减少全内镜下腰椎间盘摘除术后腰椎间盘突出的复发概率。Objective:To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture.Methods:A total of 50 patients with non-containecd lumbar disc herniation treated with full-encdoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included.Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level.The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively.The patients were followed up on the second day,3 months,6 months,and 1 year after surgery for pain relief using visual analogue scale(VAS,100-point scale).The patients were followed up at 3 months,6 months,and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI).At the 1-year follow-up,the Macnab standard of lumbar spine function was evaluated,and the recovery of nerve root function(sensory,muscular and reflex)was recorded.Results:All operations were successfully completed,of which 27 patients were treated with transforaminal approach(including 8 cases of L3,4 and 19 cases of L4,5),and 23 patients(including 11 cases of L4,5and 12 cases of L5 S1)with interlaminar approach.The average operation time was 43.2 minutes.There were no surgical complications and no recurrence of lumbar disc herniation.Postoperative lumbar MRI and C.T examinations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed.All patients had significant relief of low back pain and lower extremity radiation pain,and the ODI score improved significantly(P<0.01).At 1 year postoperative followup,17 patients got an excellent result,29 good and 4 fair according to Macnab evaluation system.On the

关 键 词：腰椎 椎间盘移位 脊柱内镜手术 微创外科手术 

分 类 号：R681.5[医药卫生—骨科学]