解放军医学院学报2017，Vol.38Issue(6)：527-530,4.DOI:10.3969/j.issn.2095-5227.2017.06.010
髂嵴高度对经皮内镜椎间孔入路治疗L5/S1椎间盘突出症的影响
Influence of iliac crest height on percutaneous transforaminal endoscopic discectomy in treatment of L5/S1 disc herniation
李宁 1黄良诚 1车路阳 1郭清华 1武成志 1黄鹏1
作者信息
摘要
Abstract
Objective To investigate the influencet of iliac crest height on the treatment of L5 / S1 disc herniation by percutaneous transforaminal endoscopic discectomy (PTED). Methods Clinical data about 172 patients who underwent PTED for L5 / S1 disc herniation in our hospital from October 2014 to October 2015 were retrospectively analyzed. According to the relationship between the highest point of the iliac crest and the L4/L5 pedicle of the lumbar in lateral radiograph, the patients were divided into 3 groups: in group I the highest point of the iliac crest was below the upper margin of the L5 pedicle. In group Ⅱ the point was between the lower margin of the L4 pedicle and the upper margin of the L5 pedicle. In group Ⅲ the point was above the lower margin of the L4 pedicle. Operative time, fluoroscopy time, and complication between the three groups were compared. Clinical outcomes were assessed by the visual analogue scale (VAS), the oswestry disability index (ODI), and the modified MacNab criteria. Results The operations were completed in all the patients. The operative time prolonged from group Ⅰ to group Ⅲ with 50.6±7.0 min, 61.9±9.6 min, and 73.1±8.0 min (P < 0.05, respectively); The fluoroscopy time prolonged from group Ⅰ to group Ⅲ with 4.7±2.2 s, 7.4±3.1 s, and 10.3±2.5 (P < 0.05, respectively); The VAS and ODI scores of each group were statistically different from those before operation (P < 0.05). There was no significant difference in VAS score and ODI score between groups at the same time point (P > 0.05). According to the improved MacNab scoring system, the excellent and good rate at three months after operation were 89.7%, 89.6%and 87.5% respectively. Conclusion In the treatment of L5/S1 disc herniation with PTED, when the iliac crest is below the upper margin of the L5 pedicle, the operation can be easily performed; when the iliac crest is between the lower margin of the L4 pedicle and the upper margin of the L5 pedicle, the surgery should be performed by a experienced surgeon; when the iliac crest is above the lower margin of the L4 pedicle, other surgical approach is recommended.关键词
腰椎间盘突出症/经皮内镜椎间孔入路/髂嵴高度/L5/S1椎间盘Key words
lumbar disc herniation/percutaneous transforaminal endoscopic discectomy/iliac crest height/L5/S1 disc herniation分类
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李宁,黄良诚,车路阳,郭清华,武成志,黄鹏..髂嵴高度对经皮内镜椎间孔入路治疗L5/S1椎间盘突出症的影响[J].解放军医学院学报,2017,38(6):527-530,4.
