后外侧入路椎间孔镜下L_5/S_1椎间盘突出伴高髂嵴髓核摘除术的技术改进
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摘要
目的探讨经皮椎间孔镜后外侧入路完成L5/S1椎间盘突出伴高髂嵴的髓核摘除术操作技巧。方法 2014年1月～2016年4月,对148例L5/S1椎间盘突出伴高髂嵴,实施经后外侧椎间孔镜椎间盘髓核摘除术,采用导杆再置和偏心环锯等改良方法。结果手术均顺利完成,术后即刻腿痛视觉模拟评分(Visual Analogue Scale,VAS)由术前(7.27±0.73)分降为(1.88±0.28)分,无感染、硬脊膜损伤及神经根损伤等并发症发生。随访12～26个月,平均16.2月。椎间盘突出复发或下肢疼痛加重9例。术后3个月[(1.82±0.32)分]、末次随访[(1.80±0.32)分]腿痛VAS评分较术前均明显降低(P=0.000),术后各时点腿痛VAS差异无统计学意义(P>0.05);术后3个月[(12.28±1.62)分]、末次随访[(11.88±1.50)分]Oswestry功能障碍指数(Oswestry Disability Index,ODI)较术前[(31.13±2.45)分]显著降低(P<0.05);末次随访改良MacNab标准优、良、可、差分别为118、16、5、9例,优良率90.5%(134/148)。结论 L5/S1椎间盘突出伴高髂嵴患者通过后外侧椎间孔入路行椎间孔镜椎间盘髓核摘除术,在导杆再置和偏心环锯等改良方法的基础上是可行和有效的。
Objective To demonstrate operative skills of percutaneous transforaminal endoscopic discectomy(PTED) for L5/S1 disc herniation with high iliac crest through posterolateral approach.Methods From January 2014 to April 2016,148 patients with L5/S1 disc herniation with high iliac crest underwent percutaneous transforaminal endoscopic discectomy via posterolateral approach.Modified techniques were used of guide rod reconfiguration and decentered reamer.Results At the end of surgery,all patients' Visual Analogue Scale(VAS) of leg pain were alleviated from(7.27±0.73) points preoperatively to(1.88±0.28)points.No infection,dural tears or nerve injuries occurred.The follow-up spanned from 12 months to 26 months(mean,16.2 months).There were 9 cases of recurrence of disc herniation or aggravated ache of lower limb.The VAS scores of leg pain at 3-month[(1.82±0.32) points]and last follow-up postoperatively [(1.80±0.32) points]were all improved as compared with pre-operation(all P=0.000),and the postoperative VAS scores in each follow-up time-point were not statistically different(P>0.05).According to the Oswestry Disability Index(ODI) for the functional status,the results demonstrated significant improvement at 3 months postoperatively [(12.28±1.62) points] and at the last follow-up [(11.88±1.51) points] when compared with that preoperatively[(31.13±2.45) points,P<0.05].The excellent,good,fair and poor outcomes based on the modified MacNab criteria at the last follow-up was 118,16,5 and 9 cases,respectively,and the excellent-or-good rate was 90.5%(134/148).Conclusion PTED for L5/S1 disc herniation with high iliac crest through posterolateral transforaminal apporach is feasible and efficient when combined with modified performance with guide rod reconfiguration and decentered reamer.
Objective To demonstrate operative skills of percutaneous transforaminal endoscopic discectomy(PTED) for L5/S1 disc herniation with high iliac crest through posterolateral approach.Methods From January 2014 to April 2016,148 patients with L5/S1 disc herniation with high iliac crest underwent percutaneous transforaminal endoscopic discectomy via posterolateral approach.Modified techniques were used of guide rod reconfiguration and decentered reamer.Results At the end of surgery,all patients' Visual Analogue Scale(VAS) of leg pain were alleviated from(7.27±0.73) points preoperatively to(1.88±0.28)points.No infection,dural tears or nerve injuries occurred.The follow-up spanned from 12 months to 26 months(mean,16.2 months).There were 9 cases of recurrence of disc herniation or aggravated ache of lower limb.The VAS scores of leg pain at 3-month[(1.82±0.32) points]and last follow-up postoperatively [(1.80±0.32) points]were all improved as compared with pre-operation(all P=0.000),and the postoperative VAS scores in each follow-up time-point were not statistically different(P>0.05).According to the Oswestry Disability Index(ODI) for the functional status,the results demonstrated significant improvement at 3 months postoperatively [(12.28±1.62) points] and at the last follow-up [(11.88±1.51) points] when compared with that preoperatively[(31.13±2.45) points,P<0.05].The excellent,good,fair and poor outcomes based on the modified MacNab criteria at the last follow-up was 118,16,5 and 9 cases,respectively,and the excellent-or-good rate was 90.5%(134/148).Conclusion PTED for L5/S1 disc herniation with high iliac crest through posterolateral transforaminal apporach is feasible and efficient when combined with modified performance with guide rod reconfiguration and decentered reamer.
引文
1 Choi KC,Park CK.Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation:consideration of the relation between the iliac crest and L5-S1 disc.Pain Physician,2016,19(2):E301-E308.
2 Yong A.Percutaneous endoscopic decompression for lumbar spinal stenosis.Expert Rev Med Devices,2014,11(6):1-12.
3格日勒,郭昭庆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展.中国微创外科杂志,2018,18(3):267-270.
4黄保华,陈远明,周先明,等.经椎间孔经皮内镜治疗复发性腰椎间盘突出症.中国微创外科杂志,2016,16(9):820-823.
5杨进,孔清泉,宋跃明.三种经皮内镜椎间盘髓核摘除术治疗伴有高髂嵴的L5/S1椎间盘突出症.中国骨与关节杂志,2014,3(8):608-614.
6杨湘江,张洪,曾月东,等.椎板间入路椎间孔镜下摘除L5/S1椎间盘突出髓核技术改进探讨.中国内镜杂志,2015,21(3):326-329.
7 Yong A,Sang-Ho L,Woo-Min P,et al.Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis.Technical note.J Neurosurg,2003,99(3 Suppl):320-323.
8 Yong A,Hyun-Kyong O,Ho K,et al.Percutaneous endoscopic lumbar foraminotomy:an advanced surgical technique and clinical outcomes.Neurosurgery,2014,75(2):124-133.
9 Yeung AT,Tsou PM.Posterolateral endoscopic excision for lumbar disc herniation:surgical technique,outcome,and complications in 307 consecutive cases.Spine,2002,27(7):722-731.
10 Lee S,Kim SK,Lee SH,et al.Percutaneous endoscopic lumbar discectomy for migrated disc herniation:classification of disc migration and surgical approaches.Eur Spine J,2007,16(3):431-437.
11 Liu KX,Massoud B.Transforaminal endoscopic lumbar procedure for disc herniations:a“between”technique.Surg Technol Int,2010,19(12):203-210.
12徐恒,简伟,谷福顺,等.经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症伴或不伴腰椎神经根管狭窄的疗效观察.中国微创外科杂志,2018,18(1):39-42.
13金丹杰,徐南伟,赵国辉,等.经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究.中国微创外科杂志,2017,17(6):491-494.
2 Yong A.Percutaneous endoscopic decompression for lumbar spinal stenosis.Expert Rev Med Devices,2014,11(6):1-12.
3格日勒,郭昭庆.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展.中国微创外科杂志,2018,18(3):267-270.
4黄保华,陈远明,周先明,等.经椎间孔经皮内镜治疗复发性腰椎间盘突出症.中国微创外科杂志,2016,16(9):820-823.
5杨进,孔清泉,宋跃明.三种经皮内镜椎间盘髓核摘除术治疗伴有高髂嵴的L5/S1椎间盘突出症.中国骨与关节杂志,2014,3(8):608-614.
6杨湘江,张洪,曾月东,等.椎板间入路椎间孔镜下摘除L5/S1椎间盘突出髓核技术改进探讨.中国内镜杂志,2015,21(3):326-329.
7 Yong A,Sang-Ho L,Woo-Min P,et al.Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis.Technical note.J Neurosurg,2003,99(3 Suppl):320-323.
8 Yong A,Hyun-Kyong O,Ho K,et al.Percutaneous endoscopic lumbar foraminotomy:an advanced surgical technique and clinical outcomes.Neurosurgery,2014,75(2):124-133.
9 Yeung AT,Tsou PM.Posterolateral endoscopic excision for lumbar disc herniation:surgical technique,outcome,and complications in 307 consecutive cases.Spine,2002,27(7):722-731.
10 Lee S,Kim SK,Lee SH,et al.Percutaneous endoscopic lumbar discectomy for migrated disc herniation:classification of disc migration and surgical approaches.Eur Spine J,2007,16(3):431-437.
11 Liu KX,Massoud B.Transforaminal endoscopic lumbar procedure for disc herniations:a“between”technique.Surg Technol Int,2010,19(12):203-210.
12徐恒,简伟,谷福顺,等.经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症伴或不伴腰椎神经根管狭窄的疗效观察.中国微创外科杂志,2018,18(1):39-42.
13金丹杰,徐南伟,赵国辉,等.经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究.中国微创外科杂志,2017,17(6):491-494.