[1]范海涛** 曹乐 朱亚坤 王汉邦 郭子明 孙凯.脊柱内镜下经椎板间隙扩大入路治疗腰椎间盘突出症[J].中国微创外科杂志,2021,01(5):410-414.
　Fan Haitao,Cao Le,Zhu Yakun,et al.Percutaneous Endoscopic Discectomy Through Extensive Interlaminar Approach in the Treatment of Lumbar Disc Herniation[J].Chinese Journal of Minimally Invasive Surgery,2021,01(5):410-414.
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脊柱内镜下经椎板间隙扩大入路治疗腰椎间盘突出症()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年5期
页码:
410-414
栏目:
临床研究
出版日期:
2021-05-25

文章信息/Info

Title:
Percutaneous Endoscopic Discectomy Through Extensive Interlaminar Approach in the Treatment of Lumbar Disc Herniation
作者:
范海涛** 曹乐 朱亚坤 王汉邦 郭子明 孙凯
（安徽医科大学附属阜阳医院骨科，阜阳230000）
Author(s):
Fan Haitao;  Cao Le;  Zhu Yakun;  et al.
Department of Orthopedics,Fuyang Hospital of Anhui Medical University, Fuyang 230000, China
关键词:
椎间盘突出症; 椎板间入路; 椎间孔镜
Keywords:
Lumbar disc herniation; Interlaminar approach; Intervertebral endoscopy
文献标志码:
A
摘要:
目的探讨脊柱内镜下经椎板间隙扩大入路治疗腰椎间盘突出症的临床效果。方法2017年7月~2019年6月我科采用脊柱内镜下经椎板间隙扩大入路手术治疗75例腰椎间盘突出症，取俯卧位，通道置入黄韧带及骨性椎板外缘，根据需要减压的部位向外上或者外下适度切除椎板扩大骨性椎管,切除部分黄韧带，推进舌瓣通道至靶部位，完成减压。比较术前后腰、腿痛视觉模拟评分（Visual Analogue Scale,VAS)和Oswestry功能障碍指数（Oswestry Disability Index,ODI)，术后6个月改良MacNab标准评价手术效果。结果75例均顺利完成手术，平均手术时间48 min（20~75 min），切口均一期愈合。术后各随访时间点下肢疼痛VAS评分均有显著性差异（P＜0.01）。术前、后腰痛VAS评分差异有显著性（P＜0.01），术后ODI改善明显（P＜0.01）。术后6个月改良MacNab标准：优65例，良9例，可1例，优良率98.7%（74/75）。结论脊柱内镜下经椎板间隙扩大入路治疗腰椎间盘突出症不破坏脊柱单元的稳定性，更加符合外科医生的视觉及操作习惯，可获得良好的临床效果。
Abstract:
ObjectiveTo evaluate the therapeutic efficacy of percutaneous endoscopic discectomy through extensive interlaminar approach in the treatment of lumbar disc herniation (LDH).MethodsA total of 75 patients with lumbar disc herniation were treated with spine endoscopy through the extensive interlaminar approach in our hospital from July 2017 to June 2019. The patients were placed in the prone position. The passage was implanted in the ligamentum flavum and the outer edge of the bony lamina. According to the part that needs to be decompressed, the lamina was appropriately removed up or down to expand the bony spinal canal. Part of the ligamentum flavum was removed, and the tongue flap passage was pushed to the target position to complete decompression. The Visual Analogue Scale(VAS) of lumbar and leg pain and Oswestry Disability Index(ODI) before and after operation were compared. The modified MacNab criteria 6 months after operation was used to evaluate the operation effect.ResultsThe surgery was successfully completed in all the 75 patients. The mean surgical time was 48 min (range,20-75 min). The wound healed by first intention without incisional infection. There were significant differences in the VAS scores of lower limb pain at each followup time point (P<0.01). There were significant differences in the VAS score of low back pain between preoperative and postoperative time points (P<0.01), and the postoperative ODI improved significantly (P<0.01). According to the modified MacNab criteria 6 months after operation, 65 cases were excellent, 9 cases were good, and 1 case was fair. The excellent and good rate was 98.7% (74/75). ConclusionThe treatment of LDH by percutaneous endoscopic discectomy through extensive interlaminar approach does not destroy the stability of the spinal unit, which is more in line with the surgeon’s vision and operating habits, and can obtain good clinical results.

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备注/Memo

备注/Memo:
基金项目：安徽省教育厅重点项目（KJ2019A0261）**通讯作者，Email：fht1881@163.com
更新日期/Last Update: 2021-08-06