椎板间隙成形技术在经椎板间入路完全内窥镜下手术治疗L4/5椎间盘突出症中的应用

Application of interlaminoplasty technique during the percutaneous endoscopic interlaminar discectomy for L4/5 disc herniation

中文关键词:  完全内窥镜  经椎板间入路  椎板间隙成形术  L4/5椎间盘突出症

英文关键词:Full-endoscopic interlaminar approach  Interlaminoplasty  L4/5 disc herniation

中文摘要:

  【摘要】 目的：评价椎板间隙成形技术在完全内窥镜 （full-endoscopic，FE）下经椎板间入路手术治疗L4/5椎间盘突出症中的应用价值及临床疗效。方法：2013年2月~2013年8月，我院应用FE下经椎板间入路手术治疗腰椎间盘突出症患者90例，男60例，女30例；年龄22~68岁，平均41.4±13.3岁。其中L4/5椎间盘突出症患者38例（A组），L5/S1椎间盘突出症患者52例（B组）。记录两组患者术前影像学参数、围手术期指标及疼痛视觉模拟评分（visual analogue scale，VAS）、腰椎Oswestry功能障碍指数（oswestry disability index，ODI），参照改良MacNab标准评价临床疗效，并进行统计学分析。结果：所有患者随访2年以上，平均34.8±4.0个月（25~42个月）。A组患者FE术中均需进行椎板间隙成形技术预处理骨性椎板窗，而B组患者未行椎板间隙成形技术。两组患者术前椎间盘突出类型方面存在显著差异（P<0.05），A组患者以肩上型椎间盘突出为主（29/38，76.3%），而B组患者以腋下型椎间盘突出最常见（34/52，65.4%）。除A组在手术时间明显大于B组外（分别为73.1±9.7min和55.2±7.5min，P<0.05），两组在住院天数、重返工作时间及并发症发生率方面均无显著差异（P>0.05）。两组患者术后VAS评分、ODI评分均较术前明显改善，末次随访时改良Macnab标准评价优良率分别为84.2%和86.5%，两组间无统计学差异（P>0.05）。结论：尽管FE下经椎板间入路手术治疗L4/5椎间盘突出症需术中采用椎板间隙成形技术预处理骨性椎板窗而延长手术时间，但仍可以获得与L5/S1节段一致的良好临床疗效，而且并未增加术后神经损伤和腰椎不稳的发生。

英文摘要:

  【Abstract】 Objectives: To evaluate the application value and clinical outcome of full-endoscopic interlaminar approach by interlaminoplasty technique for L4/5 disc herniation. Methods: From February 2013 to August 2013, 90 cases including 60 males and 30 females undergoing full-endoscopic interlaminar approach due to lumbar disc herniation in our institution were reviewed retrospectively. The age ranged from 22-68 years, with a mean of 41.4±13.3 years. 38 patients with L4/5 disc herniation were assigned in group A, and 52 patients with L5/S1 disc herniation were assigned in group B. Radiological assessments were performed and analyzed pre- and postoperatively. Clinical data including the operation time, hospitalization, time to return to work and complications were compared between the two groups. Clinical outcomes were assessed according to the visual analogue scale(VAS), Oswestry disability index(ODI) and modified MacNab criteria. Results: Follow-ups of more than 2 years were completed in all patients, the mean follow-up was 34.8±4.0 months(25-42 months). Interlaminoplasty technique was performed for access-related osseous resection at L4/5 level. A significant difference between the groups was disc type. The mean operation time in group A and B was 73.1±9.7min and 55.2±7.5min, respectively. There was a significant difference in the operation time between the two groups(P<0.05), but not in the hospitalization, time to return to work or complication rate(P>0.05). The postoperative VAS scores for back and leg pain, as well as the ODI, obviously improved in both groups when compared with preoperation(P<0.05). According to the MacNab criteria, the satisfactory rates were 84.2% and 86.5% in group A and B, respectively(P>0.05). Conclusions: Although the operation time is prolonged in L4/5 discectomy by using interlaminoplasty technique, full-endoscopic interlaminar approach can be a safe and effective technique for L4/5 disc herniation and provide an equally satisfactory clinical outcome with L5/S1 discectomy, and there is no raising of the potential risks in nerve injury and lumbar instability.