改良经椎板间入路经皮内窥镜下椎间盘切除术治疗L_(5)/S_(1)节段腰椎椎间盘突出症  

Modified percutaneous endoscopic interlaminar discectomy for treatment of L_(5)/S_(1) disc herniation

作　　者：任之强[1] 何升华[1] 张秀芳[1] 王业广[1] 孙志涛[1] 赖居易 Ren Zhiqiang;He Shenghua;Zhang Xiufang;Wang Yeguang;Sun Zhitao;Lai Juyi(Second Department of Orthopaedics,Shenzhen Traditional Chinese Medicine Hospital,Shenzhen 518034,Guangdong,China)

机构地区：[1]深圳市中医院骨二科,深圳518034

出　　处：《脊柱外科杂志》2022年第2期89-93,共5页Journal of Spinal Surgery

摘　　要：目的探讨改良经椎板间入路经皮内窥镜下椎间盘切除术(PEID)治疗L_(5)/S_(1)节段腰椎椎间盘突出症(LDH)的可行性、安全性及临床疗效。方法2018年4月—2020年1月,采用改良PEID治疗L_(5)/S_(1)节段LDH患者35例,记录术中出血量、手术时间、住院时间及并发症发生情况,术后1、6、12个月时采用疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)评估术后疼痛程度及腰椎功能改善情况,末次随访时采用改良MacNab标准评价临床疗效。结果所有手术顺利完成,所有患者随访时间超过12个月。术中出血量为5~20(12.6±3.2)mL,手术时间为39~89(67.1±11.3)min,住院时间为2~5(3.1±0.7)d。术后各随访时间点VAS评分、JOA评分和ODI较术前明显改善,差异均有统计学意义(P<0.05)。根据改良MacNab标准,末次随访时疗效优25例、良7例、可2例、差1例,优良率为91.4%。所有患者未见神经根损伤及硬膜撕裂等并发症。结论改良PEID治疗L_(5)/S_(1)节段LDH,能够经穿刺点直达突出椎间盘,避免硬膜囊挤压,减少马尾神经损伤风险,值得临床推广。Objective To investigate the feasibility,safety and clinical efficacy of modified percutaneous endoscopic interlaminar discectomy(PEID)for the treatment of L_(5)/S_(1)lumber disc herniation(LDH).Methods From April 2018 to January 2020,35 patients with L_(5)/S_(1)LDH were treated by modified PEID.Intraoperative blood loss,operation time,hospital stay and complications were recorded.The visual analog scale(VAS)score,Japanese Orthopaedic Association(JOA)score,and Oswestry disability index(ODI)were used to evaluate pain intensity and lumbar function at postoperative 1,6,and 12 months.At the final follow-up,the modified MacNab criteria was used to evaluate the clinical efficacy.Results All the operations were successfully completed.All the patients were followed up for more than 12 months.The intraoperative blood loss was 5-20(12.6±3.2)mL,operation time was 39-89(67.1±11.3)min and hospital stay was 2-5(3.1±0.7)d.The VAS score,JOA score and ODI at each follow-up time point after operation were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05).According to the modified MacNab criteria,the results were excellent in 25 cases,good in 7,fair in 2 and bad in 1.The excellent and good rate was 91.4%.There was no nerve root injury and dural tear after operation in all the patients.Conclusion Modified PEID in treatment of L_(5)/S_(1)LDH can directly reach herniated disc through puncture point,avoid dural sac squeezing and reduce risk of cauda equina injury,thus being worthy of clinical popularization.

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 经皮 外科手术 微创性 

分 类 号：R681.553.1[医药卫生—骨科学]