经皮椎间孔镜经椎间孔入路手术治疗L_5S_1椎间盘突出症的初步体会
摘要
目的探讨经皮椎间孔镜经椎间孔入路手术治疗L_5S_1椎间盘突出症的适应证、手术技巧等临床经验。方法回顾性分析自2015-01—2017-12采用经皮椎间孔镜经椎间孔入路手术治疗的50例L_5S_1椎间盘突出症。镜下用环锯部分切除患侧S1上关节突行椎间孔成形,彻底摘除突出压迫神经根的髓核,射频烧灼行纤维环成形,全程探查神经根管,确保神经根活动度超过1.0 cm。结果 50例均获得随访,随访时间平均11.2(10～12)个月。末次随访时疼痛VAS评分为0～4分,平均2.5分;ODI指数为15%～27%,平均24.1%。末次随访时疗效采用MacNab评分标准评定:优39例,良7例,可3例,差1例,优良率92.0%。结论经皮椎间孔镜经椎间孔入路手术可以完成绝大部分L_5S_1椎间盘突出症的髓核摘除,疗效满意。虽然椎间孔镜下操作学习曲线陡峭,但是严格掌握手术适应证并谨慎操作后手术风险可明显降低。
引文
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[10]查圆瑜,金伟,张树威,等.经皮椎间孔入路与椎板间入路脊柱内镜下髓核摘除术治疗L5/S1椎间盘突出症的疗效分析[J].生物骨科材料与临床研究,2017,14(1):64-68.
[2]Song H,Hu W,Liu Z,et al.Percutaneous endoscopic interlaminar discectomy of L5-S1 disc herniation:a comparison between intermittent endoscopy technique and full endoscopy technique[J].J Orthop Surg Res,2017,12(1):162.
[3]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.
[4]Macnab I.Negative disc exploration.An analysis of the causes of nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903.
[5]崔为良,王萍,廖忠.经皮椎间孔镜治疗腰椎间盘突出症的疗效分析及临床体会[J].中国骨与关节损伤杂志,2015,30(7):748-749.
[6]董健文,戎利民,冯丰,等.经皮内镜椎间孔入路腰椎间盘髓核摘除术学习曲线及其影响因素[J].中国骨与关节杂志,2013,2(4):204-210.
[7]杜明奎,管大伟,匡正达,等.经皮椎间孔镜技术治疗老年腰椎间盘突出症[J].中国骨与关节损伤杂志,2018,33(1):58-59.
[8]赵杉,刘佐庆,付文芹,等.侧路PELD治疗L5S1椎间盘突出症的影像学研究[J].中国骨与关节损伤杂志,2018,33(7):736-738.
[9]聂鸿飞,曾建成,宋跃明,等.经皮椎板间入路与经皮椎间孔入路内窥镜下椎间盘切除术治疗L5/S1椎间盘突出症的短期疗效对比较[J].中国脊柱脊髓杂志,2016,26(3):225-232.
[10]查圆瑜,金伟,张树威,等.经皮椎间孔入路与椎板间入路脊柱内镜下髓核摘除术治疗L5/S1椎间盘突出症的疗效分析[J].生物骨科材料与临床研究,2017,14(1):64-68.