不同入路及体位内镜术治疗L5S1椎间盘突出症  

Comparison of endoscopic discectomy for L5S1 disc herniation in different approaches and positions

作　　者：魏景超[1] 高尚聚[1] 李文毅[1] 张隆[1] 曹参[1] 翟金帅 WEI Jing-chao;GAO Shang-ju;LI Wen-yi;ZHANG Long;CAO Shen;ZHAI Jin-shuai(Department of Orthopedics,Hebei Provincial People's Hospital,Shijia-zhuang050051,China)

机构地区：[1]河北省人民医院骨科,石家庄050051

出　　处：《中国矫形外科杂志》2021年第1期13-17,共5页Orthopedic Journal of China

基　　金：河北省医学科学研究重点课题计划项目(编号:20150134)。

摘　　要：[目的]比较不同入路及体位行椎间孔镜手术治疗椎间盘突出症的治疗效果。[方法]回顾分析2016年2月~2018年2月行椎间孔镜手术的L5S1椎间盘突出症患者96例。其中,32例采用常规俯卧体位椎间孔入路,32例采用改良俯卧体位椎间孔入路,32例采用常规俯卧体位椎板间入路。比较3组围手术期、随访和影像资料。[结果]96例患者均顺利完成手术,术中无严重并发症发生。改良组及椎板间组患者手术时间显著短于常规组(P<0.05)。早期并发症和不良反应发生率由高至低依次为常规组(3/32)、椎板间组(2/32)、改良组(0/32),但差异无统计学意义(P>0.05)。所有患者随访12个月以上,随时间推移,3组患者腰痛和腿痛VAS评分均显著减少(P<0.05)。相应时间点,3组间腰痛和下肢痛VAS评分的差异均无统计学意义(P>0.05)。影像方面,术后12个月三组患者LCI和椎间隙高度均较术前无显著改变(P>0.05)。相应时间点,3组间腰椎曲度指数和椎间隙高度的差异均无统计学意义(P>0.05)。[结论]改良俯卧位联合椎间孔入路可缩短手术时间,降低并发症风险。[Objective]To compare the clinical outcomes of endoscopic discectomy for L5S1 disc herniation in different approaches and positions.[Methods]A retrospective study was done on 96 patients who underwent endoscopic discectomy for L5S1 disc herniation from February 2016 to February 2018 in our hospital.Of them,32 patients had endoscopic discectomy performed in conventional prone position through transforaminal approach(the conventional group),32 patients received operation in modified prone position through transforaminal approach(the modified group),and 32 patients were in conventional prone position through the interlaminar approach(the interlaminar group).The data of perioperative period,follow-up and images were compared among the 3 groups.[Results]All the patients received successful operations without serious complications.The modified group and interlaminar group consumed significantly less operation time than the conventional group(P<0.05).The occurrence of early complication and adverse reaction was ranked in the sequence of the conventional group(3/32),the interlaminar group(2/32)and the modified group(0/32),which proved statistically significant(P<0.05).As time went during follow-up period lasted for more than 12 months,the VAS scores for low back pain and leg pain significantly decreased in all the 3 groups(P<0.05).However,no statistical differences in VAS scores among the 3 groups were noticed at any corresponding time point(P>0.05).With regard to radiographic assessment,the lumbar curvature index(LCI)and the intervertebral height remained unchanged at12 months postoperatively compared with those before operation in all the 3 groups(P>0.05),which also proved not statistically different among the 3 groups at any matching time point(P>0.05).[Conclusion]The endoscopic discectomy in the modified prone position through transforaminal approach has advantages of saving operation time and reducing risk of complication for L5S1 disc herniation.

关 键 词：L5S1椎间盘突出症 内镜椎间盘切除术 手术入路 俯卧位 

分 类 号：R681.53[医药卫生—骨科学]