脊柱内镜椎板间入路治疗高髂嵴L5/S1脱垂型腰椎间盘突出症  

Endoscopic L5/S1 discectomy through interlaminar approach for the patient with the high iliac crest and migrated disc herniation

作　　者：刘少华[1] 张宏其[1] 段春岳[1] 高琪乐[1] LIU Shaohua;ZHANG Hongqi;DUAN Chunyue;GAO Qile(Department of Spine Surgery and Orthopaedics,National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科脊柱外科,中南大学湘雅医院国家老年疾病临床医学研究中心,长沙410008

出　　处：《中南大学学报（医学版）》2020年第8期948-953,共6页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2020JJ4892,2019JJ40525);中央高校基本科研业务费专项资金(2012QNZT126)。

摘　　要：目的:探讨脊柱内镜椎板间入路治疗高髂嵴L5/S1脱垂型腰椎间盘突出症的临床疗效。方法:回顾性分析2016年1月至2019年1月中南大学湘雅医院收治的31例采用脊柱内镜椎板间入路治疗高髂嵴L5/S1脱垂型腰椎间盘突出症的患者。通过术前、术后及随访时视觉模拟评分(Visual Analoge Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评估患者术前、术后的疼痛程度和腰部功能,按Macnab标准评定临床疗效。结果:31例患者术后均获得随访,时间12~48(29.68±9.64)个月。手术时间(79.16±22.43)min,透视次数2.71±0.78。患者术前VAS为7.09±0.94,术后3个月为1.45±1.23,末次随访为1.27±0.92,术后及末次随访VAS较术前明显降低(P<0.05)。术前ODI为56.03±6.64,术后3个月为16.45±6.83,末次随访为13.03±4.96,术后及末次随访ODI较术前明显降低(P<0.05)。末次随访时的临床疗效:优26例,良3例,可2例,优良率为93.5%。术后2例出现部分髓核残留,1例术后内镜翻修,1例保守治疗。1例术后即刻出现神经根刺激痛,经保守治疗后好转。结论:采用脊柱内镜椎板间入路治疗高髂嵴L5/S1脱垂型腰椎间盘突出症手术入路相对简单,透视次数少,并发症少,临床疗效满意,是一种安全可行的方法。Objective:To explore the clinical efficacy of endoscopic L5/S1 discectomy through interlaminar approach for the patient with the high iliac crest and migrated disc herniation.Methods:A retrospective study of 31 patients with the high iliac crest and migrated disc herniation at the L5/S1 level was conducted in our hospital.All of the consented patients accepted endoscopic L5/S1 discectomy through interlaminar approach from January 2016 to January 2019.Preoperative,postoperative,and follow-up Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were used to assess the pain and waist function of patients.The clinical efficacy was evaluated according to Macnab criteria.Results:All the patients were followed up for 12-48(29.68±9.64)months.The operation time was(79.16±22.43)min.The times of fluoroscopy were 2.71±0.78.The VAS of low back and leg pain was 7.09±0.94 before the surgery,1.45±1.23 at 3 months after the surgery,and 1.27±0.92 at the last follow-up.The VAS after the surgery and at the last follow-up was significantly lower than that before the operation(P<0.05).The ODI was 56.03±6.64 before the surgery,16.45±6.83 at 3 months after the surgery,and 13.03±4.96 at the last follow-up.The ODI was significantly lower after the surgery and at the last followup compared with that before the surgery(P<0.05).The Macnab score at the last follow-up was graded as excellent in 26 cases,good in 3 cases,fair in 2 cases,and the percentage of excellent and good were 93.5%.Part of the nucleus pulposus remained in 2 cases after the operation,one case underwent endoscopic revision and one case received conservative treatment;postoperative pain due to nerve root irritation was in one case and relieved by conservative treatment.Conclusion:The endoscopic L5/S1 discectomy through interlaminar approach is a relatively safe and effective treatment for the patient with the high iliac crest and migrated disc herniation,which can reduce X-ray examinations and complications,and achieve satisfactory clinical outcomes.

关 键 词：脊柱内镜 高髂嵴腰5/骶1 脱垂型腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]