脊柱内镜下经椎板锁孔技术治疗重度脱垂型腰椎间盘突出症的疗效分析
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摘要
目的探讨脊柱内镜下经椎板锁孔技术治疗重度脱垂型腰椎间盘突出症的可行性、有效性。方法回顾性分析自2015-01—2017-10采用脊柱内镜下经椎板锁孔技术治疗的12例重度脱垂型腰椎间盘突出症。比较术前及术后1 d、术后1个月腰痛VAS评分、下肢痛VAS评分及ODI指数。术后1年时采用改良MacNab评分标准评定疗效。结果本组手术时间为48～77 min,平均63 min;术中出血量为10～45 ml,平均24.2 ml。12例均获得随访,随访时间平均22.2(14～35)个月。术后3个月随访时复查腰椎MRI证实髓核均成功摘除,无残留髓核突出及复发患者。术后1年随访时采用改良MacNab评价标准评定疗效:优7例,良4例,可1例。术后1 d腰痛VAS评分、下肢痛VAS评分及ODI指数均较术前明显改善,而且术后1月以上指标较术后1 d明显改善,差异有统计学意义(P <0.05)。结论脊柱内镜下经椎板锁孔技术治疗重度脱垂型腰椎间盘突出症安全有效,创伤小、髓核摘除彻底、术后康复迅速、功能恢复满意。
Objective To investigate the feasibility and efficacy of percutaneous endoscopic lumbar discectomy(PELD) via a translaminar "Keyhole" approach for the treatment of highly down-migrated lumbar disc herniation(HD-LDH). Methods From January 2015 to October 2017, 12 patients with HD-LDH receiving PELD via a translaminar "Keyhole" approach were retrospectively analyzed. Visual analogue scale(VAS, lower back and leg) and Oswestry disability index(ODI) before operation were compared with those 1 day and 1 month after operation. Modified MacNab criterion evaluated at 1 year postoperatively was used to identify the clinical efficacy. Results The operation time was 48 to 77 minutes, with an average of 63 min; blood loss was 10 to 45 ml, with an average of 24.2 ml. All the 12 patients were followed up with an average period of 22.2(14-35)months. Lumbar MRI examined at 3 months postoperatively showed the highly down-migrated lumbar disc of the 12 patients were successfully removed without residue or re-recurrence. Modified MacNab criterion evaluated at 1 year postoperatively indicated an efficacy of 7 excellent cases, 4 good and 1 fair. VAS score of the lower back and leg and ODI score at 1 day postoperatively were significantly improved compared with preoperative ones; and values of the follow-up time points were significantly improved compared with ones 1 day after operation(P <0.05). Conclusion PELD via a translaminar "Keyhole"approach is a safe and efficient technique for the treatment of HD-LDH. The advantages are as follows: less trauma and complete disc removal, fast rehabilitation and satisfactory functional recovery.
Objective To investigate the feasibility and efficacy of percutaneous endoscopic lumbar discectomy(PELD) via a translaminar "Keyhole" approach for the treatment of highly down-migrated lumbar disc herniation(HD-LDH). Methods From January 2015 to October 2017, 12 patients with HD-LDH receiving PELD via a translaminar "Keyhole" approach were retrospectively analyzed. Visual analogue scale(VAS, lower back and leg) and Oswestry disability index(ODI) before operation were compared with those 1 day and 1 month after operation. Modified MacNab criterion evaluated at 1 year postoperatively was used to identify the clinical efficacy. Results The operation time was 48 to 77 minutes, with an average of 63 min; blood loss was 10 to 45 ml, with an average of 24.2 ml. All the 12 patients were followed up with an average period of 22.2(14-35)months. Lumbar MRI examined at 3 months postoperatively showed the highly down-migrated lumbar disc of the 12 patients were successfully removed without residue or re-recurrence. Modified MacNab criterion evaluated at 1 year postoperatively indicated an efficacy of 7 excellent cases, 4 good and 1 fair. VAS score of the lower back and leg and ODI score at 1 day postoperatively were significantly improved compared with preoperative ones; and values of the follow-up time points were significantly improved compared with ones 1 day after operation(P <0.05). Conclusion PELD via a translaminar "Keyhole"approach is a safe and efficient technique for the treatment of HD-LDH. The advantages are as follows: less trauma and complete disc removal, fast rehabilitation and satisfactory functional recovery.
引文
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[4]张海斌,许卫兵,许立臣,等.俯卧位与侧卧位下PELD治疗L5S1节段3、4取腰椎间盘突出症的比较[J].中国骨与关节损伤杂志,2017,32(11):1187-1188.
[5] Li X,Hu Z,Cui J,et al. Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation[J]. Int J Surg,2016,27:8-16.
[6] Choi KC,Kim JS,Ryu KS,et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation:transforaminal versus interlaminar approach[J]. Pain Physician,2013,16(6):547-556.
[7] Joaquim AF,Botelho RV,Mudo ML,et al. Lumbar herniated discendoscopic discectomy treatment[J]. Rev Assoc Med Bras(1992),2018,64(5):397-407.
[8] Lee S,Kim SK,Lee SH,et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation:classification of disc migration and surgical approaches[J]. Eur Spine J,2007,16(3):431-437.
[9] Lee SH,Kang BU,Ahn Y,et al. Operative failure of percutaneous endoscopic lumbar discectomy:a radiologic analysis of 55 cases[J].Spine(Phila Pa 1976),2006,31(10):E285-290.
[10] Choi KC,Lee JH,Kim JS,et al. Combination of transforaminal and interlaminar percutaneous endoscopic lumbar diskectomy for extensive down-migrated disk herniation[J]. J Neurol Surg A Cent Eur Neurosurg,2018,79(1):60-65.
[11] Ruetten S,Komp M,Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients[J]. Spine(Phila Pa 1976),2005,30(22):2570-2578.
[12] Choi G,Lee SH,Lokhande P,et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope[J]. Spine(Phila Pa 1976),2008,33(15):E508-515.
[13] Schubert M,Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation[J]. Oper Orthop Traumatol,2005,17(6):641-661.
[14] Quillo-Olvera J,Akbary K,Kim JS. Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations[J]. Acta Neurochir(Wien),2018,160(80):1603-1607.
[15] Hu QF,Pan H,Fang YY,et al. Percutaneous endoscopic lumbar discectomy for high-grade down-migrated disc using a trans-facet process and pedicle-complex approach:a technical case series[J].Eur Spine J,2018,27(Suppl 3):393-402.
[16] Inomata Y,Oshima Y,Inoue H,et al. Percutaneous endoscopic lumbar discectomy via adjacent interlaminar space for highly down-migrated lumbar disc herniation:a technical report[J]. J Spine Surg,2018,4(2):483-489.
[2] Benzakour T,Igoumenou V,Mavrogenis AF,et al. Current concepts for lumbar disc herniation[J]. Int Orthop,2019,43(4):841-851.
[3] Kambin P,Gellman H. Percutaneous lateral discectomy of the lumbar spine:a preliminary report[J]. Clin Orthop,1983,174:127-132.
[4]张海斌,许卫兵,许立臣,等.俯卧位与侧卧位下PELD治疗L5S1节段3、4取腰椎间盘突出症的比较[J].中国骨与关节损伤杂志,2017,32(11):1187-1188.
[5] Li X,Hu Z,Cui J,et al. Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation[J]. Int J Surg,2016,27:8-16.
[6] Choi KC,Kim JS,Ryu KS,et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation:transforaminal versus interlaminar approach[J]. Pain Physician,2013,16(6):547-556.
[7] Joaquim AF,Botelho RV,Mudo ML,et al. Lumbar herniated discendoscopic discectomy treatment[J]. Rev Assoc Med Bras(1992),2018,64(5):397-407.
[8] Lee S,Kim SK,Lee SH,et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation:classification of disc migration and surgical approaches[J]. Eur Spine J,2007,16(3):431-437.
[9] Lee SH,Kang BU,Ahn Y,et al. Operative failure of percutaneous endoscopic lumbar discectomy:a radiologic analysis of 55 cases[J].Spine(Phila Pa 1976),2006,31(10):E285-290.
[10] Choi KC,Lee JH,Kim JS,et al. Combination of transforaminal and interlaminar percutaneous endoscopic lumbar diskectomy for extensive down-migrated disk herniation[J]. J Neurol Surg A Cent Eur Neurosurg,2018,79(1):60-65.
[11] Ruetten S,Komp M,Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients[J]. Spine(Phila Pa 1976),2005,30(22):2570-2578.
[12] Choi G,Lee SH,Lokhande P,et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope[J]. Spine(Phila Pa 1976),2008,33(15):E508-515.
[13] Schubert M,Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation[J]. Oper Orthop Traumatol,2005,17(6):641-661.
[14] Quillo-Olvera J,Akbary K,Kim JS. Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations[J]. Acta Neurochir(Wien),2018,160(80):1603-1607.
[15] Hu QF,Pan H,Fang YY,et al. Percutaneous endoscopic lumbar discectomy for high-grade down-migrated disc using a trans-facet process and pedicle-complex approach:a technical case series[J].Eur Spine J,2018,27(Suppl 3):393-402.
[16] Inomata Y,Oshima Y,Inoue H,et al. Percutaneous endoscopic lumbar discectomy via adjacent interlaminar space for highly down-migrated lumbar disc herniation:a technical report[J]. J Spine Surg,2018,4(2):483-489.