[1]陈长青△,王成,王耀生,等.两种经皮内镜入路治疗L5S1椎间盘突出症的对比[J].中国中医骨伤科杂志,2016,24(09):25-28，32.
　CHEN Changqing,WANG Cheng,WANG Yaosheng,et al.The Comparison of Two Kinds of Percutaneous Endoscopic Approach for Treatment of L5S1 Disc Herniation[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2016,24(09):25-28，32.
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两种经皮内镜入路治疗L5S1椎间盘突出症的对比
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第24卷
期数:
2016年09期
页码:
25-28，32
栏目:
临床研究
出版日期:
2016-09-01

文章信息/Info

Title:
The Comparison of Two Kinds of Percutaneous Endoscopic Approach for Treatment of L5S1 Disc Herniation
文章编号:
1005-0205(2016)09-0025-04
作者:
陈长青1△;  王成1;  王耀生1;  周影1
1.厦门大学附属东南医院骨科,解放军第一七五医院全军 骨科中心(福建 漳州,363000)
△.通信作者 E-mail:940767191@qq.com
Author(s):
CHEN Changqing1△;  WANG Cheng1;  WANG Yaosheng1;  ZHOU Ying1
1.The Department of Orthopedics,the Affiliated Southeast Hospital of Xiamen University,the Orthopaedic Center of PLA in the 175th Hospital,Zhangzhou 363000,Fujian China.
关键词:
经皮内镜;  椎间孔入路;  椎板间入路;  L5S1椎间盘突出症
Keywords:
percutaneous endoscopic;  interlaminar;  transforaminal;  L5S1 lumbar disc herniation
分类号:
R681.5
文献标志码:
A
摘要:
目的:回顾性分析比较椎间孔与椎板间入路经皮内镜治疗L5S1椎间盘突出症的临床疗效。方法:选取符合标准的80例行经皮内镜下L5S1椎间盘切除术患者(椎间孔入路38例,椎板间入路42例),通过影像学资料分析比较两组椎间盘突出位置及大小、椎间孔高度、椎板间距离、髂嵴高度等,统计两组并发症,并使用术前术后视觉模拟疼痛评分(VAS)、Oswestry 功能障碍指数问卷表(ODI)来分析各组疗效。结果:两组均顺利完成手术,术后两组腰腿痛VAS评分、ODI评分均显著降低。在基本影像学资料统计中,髂嵴高度、椎板间距离及椎间孔高度差异无统计学意义,两组间突出椎间盘组织移位程度、移位位置差异有统计学意义。术后2例椎间孔入路未彻底减压,再次行相同入路手术; 6例(2例椎板间入路,4例椎间孔入路)复发,4例行相同入路手术,2例改行开放椎间盘切除术; 9例出现感觉运动障碍,最终1例出现足下垂; 术中6例发生了硬脊膜撕裂,都为椎板间入路,仅1例发生脑脊液漏,无感染、继发性椎间盘炎或者腹部脏器损伤发生。结论:经皮内镜下椎间盘髓核摘除术治疗L5S1椎间盘突出症安全有效,但椎间板(TF)入路对于肩型、中央型及复发型椎间盘突出有较好临床疗效,而椎间孔(IL)入路更适合于腋型及移位型特别是重度移位型椎间盘突出症,具体疗效与操作者熟练程度及对适应症把握有直接关系。
Abstract:
Objective:To retrospectively analyze the clinical effect of transforaminal and interlaminar approach percutaneous endoscopic treatment of L5S1 disc herniation. Methods:80 cases of patients with L5S1 herniation were selected according to the standard(transforaminal approach in 38 cases,interlaminar approach in 42 cases). The position and size of the intervertebral disc protrusion,the height of the intervertebral foramen,the distance between the vertebral lamina and the height of the iliac crest were analyzed and compared through the imaging data of the two groups. The complications,VAS score and ODI before and after operation of the two groups were analyzed to compare the efficacy of the two groups. Results:Both groups successfully completed the surgery. After operation,the VAS score and ODI score of the two groups were significantly decreased. There was no significant difference in iliac crest height,vertebral plate distance and intervertebral foramen height. There was a significant difference in the degree of intervertebral disc displacement and the position of the intervertebral disc between the two groups. After operation,2 cases of intervertebral foramen were not completely reduced,and the same operation was performed again. In 6 cases(2 cases of interlaminar approach,4 cases of transforaminal approach)of recurrence,4 patients underwent the same surgical approach and 2 cases diverted open intervertebral disc resection. 9 cases appeared sensory motor disorders,and finally 1 case had foot drop. Dural tear occurred in 6 cases,both of which were in the lamina approach,only 1 case had cerebrospinal fluid leakage. No infection,secondary inflammation of the intervertebral disc or abdominal organs injury occurred. Conclusions:The percutaneous endoscopic discectomy in the treatment of L5S1 disc herniation is safe and effective. TF approach has good clinical effect on shoulder,central and recurrent lumbar disc herniation. The IL approach is more suitable for the axillary type and the shift type,especially for the severe displaced disc herniation. The specific therapeutic effect is directly related to the operation skill and the indications of the treatment.

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更新日期/Last Update: 2016-09-15