改良椎板间隙入路经皮内镜下椎间盘切除术治疗L5/S1椎间盘突出症的疗效观察

The efficacy of modified percutaneous endoscopic interlaminar discectomy in the treatment of L5/S1 disc herniation

中文关键词:  经皮内镜下腰椎间盘切除术  腰椎间盘突出症  改良椎板间隙入路  黄韧带  微创

英文关键词:Percutaneous endoscopic lumbar discectomy  Lumbar disc herniation  Modified interlaminar approach  Ligamentum flavum  Minimally invasive

中文摘要:

  【摘要】 目的：探讨改良椎板间隙入路经皮内镜下椎间盘切除术（modified percutaneous endoscopic interlaminar discectomy，MPEID）治疗L5/S1椎间盘突出症的临床疗效。方法：2018年12月~2021年5月我院对123例符合纳入标准的L5/S1椎间盘突出症患者采用MPEID治疗，其中男65例，女58例；年龄16~83岁（44.43±12.67岁）。术前、术后和末次随访时进行疼痛视觉模拟评分（visual analogue scale，VAS），术前和末次随访时进行Oswestry功能障碍指数（Oswestry disability index，ODI）评定，末次随访时根据改良Macnab标准评定疗效。结果：123例均顺利完成手术，手术时间为45.96±21.87min，术中出血量为5.93±3.15ml。术后出现并发症8例，发生率为6.5%。复发3例，复发率为2.4%。术后随访时间为6~35个月（16.49±7.30个月）。术前、术后及末次随访时腰腿痛VAS评分分别为5.29±1.71、2.89±0.75和0.59±0.72（P<0.05）；术前与末次随访时的ODI分别为（61.14±13.93）%、（7.47±10.46）%，末次随访ODI改善明显（P<0.05）。末次随访改良MacNab标准评定：优100例，良20例，可2例，差1例，优良率97.6％（120／123）。结论：MPEID治疗L5/S1椎间盘突出症能够保留黄韧带，早期临床疗效满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcome of modified percutaneous endoscopic interlaminar discectomy(MPEID) in the treatment of L5/S1 disc herniation. Methods: All 123 patients diagnosed of L5/S1 disc herniation(65 males and 58 females, age from 16 to 83 years, mean age 44.43±12.67 years) were treated with MPEID in our spine surgery center. Visual analogue scale(VAS) was scored before operation, after operation and at the last follow-up. Oswestry disability index(ODI) was evaluated before operation and at the last follow-up. The clinical effect was assessed according to the modified Macnab standard at the final follow-up. Results: Operations were successfully completed in all the 123 patients. The operation time was 45.96±21.87min. The intraoperative blood loss was 5.93±3.15ml. All patients were followed up for 6-35 months(16.49±7.30 months). 8 cases occurred postoperative complications, with an incidence of 6.5%. There were 3 cases of recurrence, with a recurrence rate of 2.4%. The pre-operative, post-operative and final follow-up VAS scores were 5.29±1.71, 2.89±0.75, and 0.59±0.72, respectively(P<0.05). The last follow-up ODI improved significantly(P<0.05). According to the modified MacNab criteria, 100 cases were excellent, 20 cases were good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 97.6%(120/123). Conclusions: MPEID has a satisfactory early clinical outcome in the treatment of L5/S1 disc herniation, whichpreserves the ligamentum flavum.