经皮激光腰椎间盘减压术后腰椎关节突关节和椎间高度的变化

目的：观察经皮激光椎间盘减压术（percutaneous laser disc decompression，PLDD）治疗腰椎间盘突出症术后腰椎关节突关节和椎间高度的变化。方法：应用半导体激光系统对32例腰椎间盘突出症患者进行PLDD治疗。29例患者为单节段突出，其中L3/4 3例，L4／5 18例，L5/S1 8例；3例患者同时合并IA／5和L5/S1节段突出。利用Macnab标准评价随访患者的疗效，并观察术前、术后椎间盘突出节段关节突关节角的形态，测量L3，4、L4/5和L5／S1椎间高度指数和椎间盘突出节段关节突关节角的角度。结果：所有患者无术中和术后并发症。随访14～22个月，平均17个月，按Macnab标准评价：优14例（43．75％），良13例（40．63％）；可3例（9．37％），差2例（6．25％），优良率84．38％。术后L5/S1椎间高度指数与术前相比显著性下降（P〈0．05），但L3/4和L4／5椎间高度指数无显著性改变；关节突关节无明显退变；L4／5和L5／S1椎间盘突出侧的关节突关节角角度显著性下降（P〈0．05），但L3/4椎间盘突出侧的关节突关节角度无显著性改变。结论：经皮激光腰椎间盘减压术后患者的L5／S1椎间高度和腰椎间盘突出侧关节突关节角角度下降．有可能增加腰椎滑脱的风险。

Lumbar facet joint change and intervertebral height loss after percutaneous laser disc decompression

Objective:To investigate the influences of percutaneous laser disc decompression (PLDD) on the lumbar facet joint and intervertebral height.Method:Thirty two cases of lumbar disc protrusion were treated with PLDD using semiconducting laser system.Among all the eligible participants,29 patients had only one protrution,3 patients had two protrution at L4/5 and L5/S1.There were 3 in L3/4,21 in L4/5 and 11 in L5/S1 with the total of 35 protrusions.All patients were followed up and evaluated based on the Macnab criteria.The morphology of lumbar facet joints was observed.Index of intervertebral height and the changes of facet joint angles of L3/4,L4/5 and L5/S1 were measured in the herniated discs.Result:No complications were occurred during the operation and follow-up.All patients were followed up for an average period of 17 months(14~22 months).According to Macnab criteria,14 patients(43.75%) showed excellent,13 patients(40.63%) were good,3 patients (9.37%) were fair and 2 patients(6.25%) were poor.Compared with values of pre-operation,index of intervertebral height of post-operation decreased significantly at L5/S1(P<0.05),but not the same case in L3/4 and L4/5.No facet degeneration was noted.The angle of facet joints on the side of disc protrusion decreased significantly at L4/5 and L5/S1,but not the same case in L3/4.Conclusion:PLDD is a safe and effective interventional therapy to lumbar intervertebral disc protrusion,but it can result in the decrease of intervertebral height at level L5/S1 and facet joint angle on the side of disc protrusion.