经皮内镜治疗L_(5)S_(1)极外侧椎间盘突出症的临床体会  

Clinical Experience of Percutaneous Endoscopic Transforaminal Discectomy for L_(5)S_(1) Far Lateral Lumbar Disc Herniation

作　　者：张同会 李涛 席金涛 罗程 唐谨 李莹 刘鏐 吴从俊 ZHANG Tonghui;LI Tao;XI Jintao;LUO Cheng;TANG Jin;LI Ying;LIU Liu;WU Congjun(Hubei 672Orthopaedic Hospital of Integrated Traditional Chinese and Western Medicine,Wuhan 430079,China)

机构地区：[1]湖北六七二中西医结合骨科医院脊柱微创科,武汉430079

出　　处：《中国中医骨伤科杂志》2022年第5期46-50,共5页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：湖北陈孝平科技发展基金会(CXPJJH12000005-07-10)。

摘　　要：目的:探讨经皮内镜治疗L_(5)S_(1)极外侧椎间盘突出症的临床疗效及操作体会。方法:回顾性分析2017年11月至2021年3月间收治的23例L_(5)S_(1)极外侧椎间盘突出症患者临床资料,采取局麻下经皮内镜椎间孔入路术式完成,年龄41~65岁,采用VAS评分、ODI评分及MacNab标准评价手术效果。结果:手术平均时长为57min,平均出血量约为15mL;23例患者随访3~18个月,平均为12.5个月,其中18例患者完整随访1年以上。对手术前后VAS评分、ODI评分进行统计学分析,术后1d与术前,术后3个月与术后1d差异有统计学意义(P<0.05),术后12个月与术后3个月差异无统计学意义(P>0.05)。MacNab标准评价临床疗效,优18例,良3例,可1例,差1例,优良率为91.30%。结论:经皮内镜治疗L5S1极外侧椎间盘突出症具有靶向性强、损伤小、康复快等优势,但术前应全面评估患者椎间隙高度、腰骶角、横突、髂骨、椎间盘突出的位置,避免损伤出孔神经根及影响疗效。Objective:To investigate the clinical efficacy and operation experience of percutaneous endoscopic transforaminal discectomy for L_(5)S_(1)far lateral lumbar disc herniation.Methods:Clinical data of 23patients with L_(5)S_(1) far lateral lumbar disc herniation from November 2017to March 2021were retrospectively analyzed.Percutaneous endoscopic transforaminal discectomy approach was performed under local anesthesia,aged 41to 65years old,and the surgical results were evaluated by VAS score,ODI score,and MacNab standard.Results:The average duration of surgery was 57min,and the average blood loss was about 15mL.23patients were followed up for 3to 18months with an average of 12.5months,and 18patients were followed up for more than one year.The VAS score and ODI score before and after surgery were statistically analyzed,and there were significant differences between 1dafter surgery and before surgery,3months after surgery and 1dafter surgery(P<0.05).There was no significant difference between l2month and 3months after operation(P>0.05).MacNab standard evaluation of clinical efficacy was excellent in 18cases,good in 3cases,fair in 1case and poor in 1case,with an excellent and good rate of 91.30%.Conclusion:Percutaneous endoscopic transforaminal discectomy for L_(5)S_(1) far lateral lumbar disc herniation has the advantages of strong targeting,little injury and quick recovery,etc.But preoperative comprehensive evaluation should be made of patients'intervertebral space height,lumbosacral angle,transverse process,iliac bone and the position of disc herniation to avoid damage to the perforation root and affect the curative effect.

关 键 词：经皮内镜 极外侧椎间盘突出症 椎间隙高度 腰骶角 

分 类 号：R681.5[医药卫生—骨科学]