钝性分离黄韧带在脊柱内镜下L5~S1椎间盘摘除术中的应用

目的探讨钝性分离黄韧带技术在脊柱内镜下经椎板间入路L5~S1椎间盘摘除术中的应用价值。方法采用钝性分离黄韧带技术行脊柱内镜下经椎板间入路椎间盘摘除术治疗24例L5~S1椎间盘突出症患者。观察手术并发症发生情况;记录腰腿疼痛NRS评分及ODI评分评价疼痛及功能障碍情况;术后6个月采用改良MacNab标准评价疗效。结果患者均获得随访,时间6~14个月。无神经损伤、脑脊液漏和感染等并发症发生。腰腿疼痛NRS评分及ODI评分术后3 d、1个月、3个月、6个月时均低于术前(P<0.05)。术后6个月按改良MacNab标准评价疗效:优19例,良3例,可2例,优良率22/24。结论钝性分离黄韧带技术应用于脊柱内镜下L5~S1椎间盘摘除术安全有效,但要严格掌握手术适应证。

Application of blunt dissection ligamentum flavum technique in percutaneous endoscopic interlaminar discectomy for L5~S1 disc herniation

Objective To investigate the application value of blunt dissection ligamentum flavum technique during percutaneous endoscopic interlaminar discectomy for L5~S1 disc herniation.Methods All 24 cases of L5~S1 disc herniation were treated with percutaneous endoscopic translaminar discectomy with blunt dissection ligamentum flavum.The complication of the surgery was observed.NRS of lumbocrural pain and ODI were recorded to assess the degree of pain and dysfunction.At 6 months postoperation,modified MacNab standard was used to evaluate the therapeutic effect.Results All patients were followed up for 6~14 months.No serious complications occurred,such as neural lesion,leakage of cerebrospinal liquid,infection,etc.At 3 d,1,3,6 months postoperation,the postoperative NRS of low back and leg pain and ODI were lower than the preoperative ones(P<0.05).In terms of the modified MacNab at postoperative 6 months,19 cases obtained excellent outcome,3 good,and 2 fair,the excellent and good rate was 22/24.Conclusions Blunt dissection ligamentum flavum technique is used during percutaneous endoscopic interlaminar discectomy at L5~S1 level,which is safe and effective,but the surgical indication should be strictly mastered.