经对侧椎间孔入路内镜治疗L5/S1近端游离型腰椎间盘突出症  

Endoscopic Treatment of L5/S1 Proximal Sequestered Lumbar Disc Herniation Through Contralateral Intervertebral Foramen Approach

作　　者：邢建强[1] 冯晴[1] 刘栋[1] 刘彬 邵滨[1] Xing Jianqiang;Feng Qing;Liu Dong(Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou 256603, China)

机构地区：[1]滨州医学院附属医院脊柱外科,滨州256603

出　　处：《中国微创外科杂志》2021年第2期126-129,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经对侧椎间孔入路内镜下治疗L5/S1高度近端游离型腰椎间盘突出症(sequestered lumbar disc herniation,SLDH)的安全性及疗效。方法2015年1月~2019年1月我院采用经对侧椎间孔入路内镜下治疗L5/S1高度近端SLDH 46例,患侧卧位,定位L4/5椎间隙,棘突中线旁开10~12 cm健侧作为进针点,建立工作通道至Ⅰ区,内镜下取出游离髓核组织。比较手术前后腰、腿痛视觉模拟评分(Visual Analogue Scale,VAS)和Oswestry功能障碍指数(Oswestry Disability Index,ODI),采用改良MacNab标准评价疗效,观察术后1年复发率。结果术后1周腰、腿痛VAS评分分别为(2.5±0.4)、(3.0±0.4)分,术后1年分别为(1.6±0.3)、(1.9±0.3)分,与术前(5.8±0.5)、(7.1±0.6)分比较明显改善(均P=0.000);ODI术后1周、1年分别为(22.6±4.1)%、(9.8±2.8)%,与术前(69.2±1.6)%比较差异有统计学意义(均P=0.000)。改良MacNab评定标准评价疗效,术后1周、1年优良率分别为89.1%(41/46)、93.5%(43/46)。术后1年随访复发率2.2%(1/46)。结论经对侧椎间孔入路内镜下治疗L5/S1高度近端游离型腰椎间盘突出症近期临床疗效良好。Objective To investigate the safety and efficacy of endoscopic treatment of L5/S1 high proximal sequestered lumbar disc herniation(SLDH)through the contralateral intervertebral foramen approach.Methods From January 2015 to January 2019,46 cases of L5/S1 high proximal SLDH were given endoscopic treatment through the contralateral intervertebral foramen approach.The patient was placed in the lateral lying position,and the L4/5 intervertebral space was located.The healthy side of the midline of spinous process was opened 10-12 cm apart as the insertion point,and the working channel was established to the AreaⅠ.The free nucleus pulposus tissue was removed under the endoscope.The Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)of lumbago and leg pain were compared before and after operation.Efficacy was evaluated by improved MacNab standard,and recurrence rate was observed a year after operation.Results The VAS scores for lumbago and leg pain a week after surgery were(2.5±0.4)and(3.0±0.4)points,respectively;the VAS scores for lumbago and leg pain a year after surgery were(1.6±0.3)and(1.9±0.3)points,respectively,which were significantly improved compared with those before surgery(all P=0.000).The ODI a week and a year after operation were(22.6±4.1)%and(9.8±2.8)%,respectively,with statistically significant difference from the preoperative comparison[(69.2±1.6)%,all P=0.000].The improved MacNab standard was used to evaluate the efficacy,and the excellent and good rates were 89.1%(41/46)and 93.5%(43/46)at a week and a year after the operation,respectively.The recurrence rate was 2.2%(1/46)after a year follow-up.Conclusion Endoscopic treatment of L5/S1 high proximal SLDH through the contralateral intervertebral foramen approach has good short-term efficacy.

关 键 词：游离型腰椎间盘突出症 椎间孔 对侧椎间孔入路 

分 类 号：R68[医药卫生—骨科学]