经椎板间入路联合镜下磨钻治疗L_(5)-S_(1)重度远端脱垂型椎间盘突出疗效分析  

Effectiveness of percuteneous intervertebral foraminoscopy lumbar discectomy using a interlaminar approach combined with microscopic grinding drill in the treatment of L_(5)-S_(1)severe down-migrated disc herniation

作　　者：齐祥如 周峰 高一淋 李云鹏 QI Xiangru;ZHOU Feng;GAO Yilin;LI Yunpeng(Department of Orthopaedics,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou 221100)

机构地区：[1]徐州医科大学附属徐州市立医院骨科,徐州221100

出　　处：《颈腰痛杂志》2025年第1期166-170,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：徐州医科大学附属医院发展基金优秀人才基金项目(XYFY2021033)。

摘　　要：目的探讨椎间孔镜下经椎板间入路联合镜下磨钻治疗L_(5)-S_(1)重度远端脱垂(Lee分型IV区脱垂型)椎间盘突出的临床疗效。方法回顾性分析2017年6月至2021年6月徐州医科大学附属徐州市立医院骨科收治的采用椎间孔镜经椎板间入路联合镜下磨钻治疗L_(5)-S_(1)重度远端脱垂型椎间盘突出的31例患者。通过对比视觉模拟评分(VAS)和Oswestry功能障碍指数(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例患者术后平均获得随访3个月。手术时间(80.52±14.36)min,透视(3.38±1.20)次。患者术前VAS为(7.48±0.93),术后3 d为(2.14±0.85),随访3个月为(1.76±0.54),术后3 d及随访3个月VAS较术前明显降低(P<0.05)。术前ODI为(56.52±3.91),术后3 d为(16.35±3.38),随访3个月为(13.74±2.43),术后3 d及随访3个月ODI较术前明显降低(P<0.05)。末次随访时的临床疗效:优22例,良7例,可2例,优良率为93.5%。结论采用椎间孔镜经椎板间入路联合镜下磨钻治疗L_(5)-S_(1)重度远端脱垂型椎间盘突出,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 investigate the clinical effects of percuteneous intervertebral foraminoscopy lumbar discectomy using a interlaminar approach combined with microscopic grinding drill in the treatment of L_(5)-S_(1)severe down-migrated disc herniation.Methods Retrospective analysis was performed on 31 patients with L_(5)-S_(1)severe down-migrated disc herniations treated by percuteneous intervertebral foraminoscopy lumbar discectomy using a interlaminar approach combined with microscopic grinding drill in the orthopedics department of Xuzhou Municipal Hospital affiliated to Xuzhou Medical University from June 2017 to June 2021.The visual analoge scale(VAS)and Oswestry disability index(ODI)were compared to evaluate the degree of pain and lumbar function pre-and postoperative,and the clinical efficacy was evaluated according to MacNab standard.Results All the 31 patients were followed up for 3 months.The operative time was(80.52±14.36)min,and the fluoroscopy frequency was(3.38±1.20).The VAS was(7.48±0.93)in preoperative,(2.14±0.85)on the third day after operation,and(1.76±0.54)after 3 months follow-up.For the VAS scores,there were significant differences between pre-and postoperative(P<0.05).ODI was(56.52±3.91)in preoperative,(16.35±3.38)on the third day after operation,and(13.74±2.43)after 3 months follow-up.ODI was significantly lower on the third day postoperation and 3 months after follow-up than preoperation(P<0.05).At the last follow-up,the clinical efficacy was excellent in 22 cases,good in 7 cases and fair in 2 cases,and the excellent and good rate was 93.5%.Conclusion The treatment of L_(5)-S_(1)severe down-migrated disc herniations by percuteneous intervertebral foraminoscopy lumbar discectomy using a interlaminar approach combined with microscopic grinding drill is a safe and feasible method with a relatively simple surgical approach,fewer fluoroscopy,fewer complications and satisfactory clinical efficacy.

关 键 词：椎间孔镜 椎板间入路 镜下磨钻 椎间盘突出 Lee分型 远端脱垂 

分 类 号：R681.57[医药卫生—骨科学]