完全内窥镜下经椎板间入路手术治疗腰椎间盘突出症中期临床疗效

目的：评价完全内窥镜（full-endoscopic，FE）下经椎板间入路手术治疗腰椎间盘突出症的中期临床疗效。方法2008年8月至2010年2月，我院应用FE经椎板间入路手术治疗腰椎间盘突出症患者45例，男25例，女20例；年龄19～58岁，平均38.3岁。术前、术后3个月、术后1年和末次随访进行腿、腰痛视觉模拟评分（visualanalogescale，VAS）和腰椎Oswestry功能障碍指数（oswestrydisabilityindex，ODI）评定，参照改良MacNab标准评价临床疗效，并进行统计学分析。结果所有病例手术均顺利完成，平均手术时间62.4min；平均住院时间5.2天；2例术中出现硬膜小裂口，未予处理；无神经根损伤及术后出血等并发症发生。术后随访48～66个月。腿痛VAS评分从术前（7.6±1.6）分降至术后3个月（1.2±0.8）分、术后1年（1.1±0.9）分、末次随访（1.6±1.2）分（P＜0.01），末次随访与术后1年比较，差异无统计学意义（P＞0.05）；腰痛VAS评分从术前（3.1±2.2）分降至术后3个月（1.8±1.5）分、术后1年（1.6±1.4）分、末次随访（1.7±0.9）分（P＜0.01），末次随访与术后1年比较，差异无统计学意义（P＞0.05）；腰椎ODI指数从术前（69.5±10.5）降至术后3个月（19.3±6.5）、术后1年（15.6±5.9）、末次随访（21.8±7.0）（P＜0.01），末次随访与术后1年比较，差异无统计学意义（P＞0.05）。末次随访时，93.3%的患者获得良好的主观满意度，临床疗效优良率为88.9%。性别、年龄、突出类型及术前腰痛与改良MacNab结果无相关性（P＞0.05）；而术前Pfirrmann分级、感觉缺陷及手术节段与改良MacNab结果具相关性（P＜0.05）。1例L4～5节段患者术后1周发生下肢麻木加重，予以脱水、激素治疗等保守治疗后2周症状缓解；1例L5～S1节段患者术后4个月出现手术节段椎间盘再次突出，行小切口开放手术翻修。末次随访时，2例轻度运?

Mid-term clinical outcomes of full-endoscopic interlaminar approach for lumbar disc herniation

Objective To evaluate the mid-term clinical outcomes of full-endoscopic （ FE ） interlaminar approach for lumbar disc herniation. Methods A retrospective study of 45 patients with lumbar disc hernation undergoing FE interlaminar approach from August 2008 to February 2010 was carried out. There were 25 males and 20 females, whose mean age was 38.3 years old （ range：19-58 years ）. The Visual Analogue Scale （ VAS ） of low back pain and leg pain and Oswestry Disability Index （ ODI ） were evaluated preoperatively, at 3 months and 1 year after the operation and in the latest follow-up. The modiifed Macnab criteria was used to assess the clinical outcomes, and all the data was statistically analyzed. Results The operation was successfully completed in all the patients. The mean operation time was 62.4 min, and the mean length of hospital stay was 5.2 d. Small dural tears were noticed during the operation in 2 patients, which were not handled. There were no nerve root injuries or postoperative blood loss. All the patients were followed up from 48 to 66 months. The VAS score of leg pain was （ 7.6±1.6 ） points preoperatively, which was reduced to （ 1.2±0.8 ）, （ 1.1±0.9 ） and （ 1.6±1.2 ） points at 3 months and 1 year after the operation and in the latest follow-up respectively （ P〈0.01 ）. No statistically signiifcant differences existed between the scores in the latest follow-up and that at 1 year after the operation （ P〉0.05 ）. The VAS score of low back pain was （ 3.1±2.2 ） points preoperatively, which was reduced to （ 1.8±1.5 ）, （ 1.6±1.4 ） and （ 1.7±0.9 ） points at 3 months and 1 year after the operation and in the latest follow-up respectively （ P〈0.01 ）. No statistically signiifcant differences existed between the scores in the latest follow-up and that at 1 year after the operation （ P〉0.05 ）. The ODI score was （ 69.5±10.5 ） points preoperatively, which was reduced to （ 19.3±6.5 ）, （ 15.6±5.9 ） and （ 21.8±7.0 ） points