临床骨科杂志Issue(4)：410-413,4.DOI:10.3969/j.issn.1008-0287.2015.04.008
经椎板间隙内镜下L5~S1椎间盘摘除术疗效观察
Clinical observation of the outcome of full-endoscopic L5 ~S1 discectomy through interlami- nar approach
黄金河 1赵玉驰 1王力刚 1许军1
作者信息
- 1. 深圳市第七人民医院骨科，广东 深圳 518081
- 折叠
摘要
Abstract
Objective To summarize the experience of full-endoscopic L5 ~S1 discectomy through interlaminar ap-proach and evaluate its clinical effect. Methods 32 cases of imtracanalicular non-contained disc herniations at the L5 ~S1 level were treated with full-endoscopic discectomy through interlaminar approach. L5 ~S1 disc herniation was divided into three types according to position of herniated disc related to S1 nerve root:axilla type (14 cases), ventral type (11 cases), shoulders type (7 cases). Axilla approach were selected for axilla type with the endoscope and worked channel placed at the axilla between S1 nerve root and dural sac while shoulder approach were selected for ventral type and shoulder type with the endoscope and working channel placed at the shoulder lateral to S1 nerve root. Prolapsed or sequestered disc materials were resected with intradiscal loosening tissue taken out simultaneously through the same approach. MRI was reexamined 3 days and 3 months after operation to evaluate the resection com-pleteness of prolapsed disc material. Visual analogue scales ( VAS) of low back pain and sciatica, Oswestry disability index (ODI) of preoperative, postoperative 3,6,12 months were recorded and compared. MacNab scores were evalu-ated in the 12-month follow-up. The intervertebral space height was evaluated by Robert standard and MRI. Results Operation time was 30~85(45. 3 ± 15. 8) min. All cases were followed up for 18~42(25. 8 ± 8. 4) months. The preoperative value of the intervertebral space height was 2. 13 ± 0. 56, while that was 2. 63 ± 0. 61 of the final follow-up value. There were significant differences ( P<0. 01 ) . No nerve injury and infection were complicated. Only 1 case of reoccurrence was revised with microendoscopic discectomy no recurrence in 17 months follow-up. Postopera-tive ODI and VAS of lowback pain and sciatica were significantly decreased in 3,6,12 months (P<0. 01). MacNab scores of postoperative 12 months follow-up included excellent in 22 cases, good in 8, fair in 1 and poor in 1. The functional status of S1 nerve in the 12 months follow-up postoperatively:the feel and muscle power function of S1 nerve root area increased significantly (P<0. 01),no significantly altered in Achilles tendon reflex,compared with the pre-operation ( P>0. 05 ) . Conclusions Full-endoscopic L5 ~S1 discectomy through interlaminar approach is a safe, rational and effective minimally invasive spine surgery technique with excellent clinical short-term outcomes.关键词
经皮内窥镜/椎间盘摘除术/腰椎间盘突出症/微创脊柱外科Key words
percutaneous endoscopy/discectomy/lumbar disc herniation/minimally invasive spine surgery分类
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黄金河,赵玉驰,王力刚,许军..经椎板间隙内镜下L5~S1椎间盘摘除术疗效观察[J].临床骨科杂志,2015,(4):410-413,4.
