邓中博;吴添龙;何丁文;陈伟才;张磊磊;程细高;

• 1:南昌大学第二附属医院江西骨科研究所

摘要(Abstract)：

[目的]回顾性分析经皮椎板间神经根肩侧入路内镜治疗L_5S_1椎间盘突出症的临床疗效,探讨此微创技术的优越性。[方法]2013年8月~2015年3月,对收治的45例L_5/S_1椎间盘突出症患者采用经皮椎板间神经根肩侧入路行微创髓核摘除术治疗。统计手术时间、术中出血量、术后并发症、住院时间等指标。术前和术后即刻、术后1个月及3个月直腿抬高角度和疼痛视觉模拟评分,术前和术后定期随访评估Oswestry功能障碍指数并采用改良MacNab标准判定疗效。[结果]术后即刻及术后1、3个月的直腿抬高角度分别为(65.74±3.58)°、(69.45±4.31)°、(70.65±4.21)°,均较术前的(26.78±3.65)°显著增加(P<0.05);术后即刻及术后1、3个月的VAS评分分别为(3.27±0.69)、(2.48±0.42)、(2.15±0.26),均较术前的(7.81±1.49)显著改善(P<0.05);术后3个月的ODI指数为(13.54±5.39)%,低于术前的(79.32±10.11)%(P<0.05)。术后3个月根据改良MacNab标准评价疗效,优良率为95.5%(43/45)。无并发症发生。[结论]经皮椎板间神经根肩侧入路内镜治疗L_5/S_1椎间盘突出症短期内疗效确切,手术风险小,并发症少。

关键词(KeyWords)： 神经根肩侧;椎板间;腰椎间盘突出症;内镜

Abstract:

Keywords:

基金项目(Foundation): 江西省卫生厅科技项目(编号:20141059)

作者(Author): 邓中博;吴添龙;何丁文;陈伟才;张磊磊;程细高;

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DOI:

参考文献(References)：

• [1]周跃,李长青,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
• [2]Ruetten S,Komp M,Godolias G.Lumbar discectomy with the fullendoscopic interlaminar approach using newly-developed optical systems and instruments[J].WSJ,2006,1(3):148-156.
• [3]Ebraheim NA,Miller RM,Xu R,et al.The location of the intervertebral lumbar disc on the posterior aspect of the spine[J].Surg Neurol,1997,48(3):232-236.
• [4]Veresciagina K,Spakauskas B,Ambrozaitis KV.Clinical outcomes of patients with lumbar disc herniation,selected for one-level opendiscectomy and microdiscectomy[J].Eur Spine J,2010,19(9):1450-1458.
• [5]Ruetten S,Komp M,Merk H,et al.Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique:a prospective,randomized,controlled study[J].Spine,2008,33(9):931-939.
• [6]Wang J,Zhou Y,Zhang ZF,et al.Disc herniation in the thoracolumbar junction treated by minimally invasive transforaminal interbody fusion surgery[J].J Clin Neurosci,2014,21(3):431-435.
• [7]Yeung AT.The evolution of percutaneous spinal endoscopyand discectomy:state of the art[J].Mt Sinai J Med,2000,67(4):327-332.
• [8]Hoogland T,Schubert M,Miklitz B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of a lowdose chymopapain:a prospective randomized study in 280 consecutive cases[J].Spine,2006,31(24):890-897.
• [9]Kambin P,O’Brien E,Zhou L,et al.Arthroscopic microdiscectomy and selective fragmentectomy[J].Clin Orthop,1998,347(347):150-167.
• [10]Choi G,Lee SH,Deshpande K,et al.Working channel endoscope in lumbar spine surgery[J].J Neurosurg,2014,58(1):77-85.
• [11]Choi G,Lee SH,Raiturker PP,et al.Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5S1using a rigid working channel endoscope[J].Neurosurgery,2006,58(1):59-68.
• [12]Ruetten S,Komp M,Godolias G.A new full endoscopic technique for the interlaminar operation of lumbar disc herniations using 6mm endoscopes:prospective 2 year results of 331 patients[J].Minim Invasive Neurosurg,2006,49(2):80-87.
• [13]张西峰,王岩,肖嵩,等.内窥镜下不同入路治疗L5/S1椎间盘突出症[J].中华骨科杂志,2010,30(4):341-345.
• [14]Hsien TC,Chun HT,Shao CC,et al.Endoscopic discectomy of L5S1disc herniation via an interlaminar approach:prospective controlled study under local and general anesthesia[J].Surg Neurol Int,2011,328(2):93.