经皮内镜辅助下经椎板间隙椎间融合治疗L5S1椎间盘突出症

目的：观察经皮内镜辅助下经椎板间隙腰椎椎间融合术（percutaneous endoscopic translaminar lumbar interbody fusion，PE-TLIF）治疗L₅S₁椎间盘突出症的有效性及安全性。方法：对2018年1月至2019年12月实施PE-TLIF治疗的37例L₅S₁椎间盘突出患者进行回顾性分析，其中男16例，女21例；年龄30~68（45.62±13.57）岁；体质量指数19.5~28.8（24.33±3.51）kg/m²；病程18~48（27.18±6.65）个月。记录手术时间、术中出血量、术后引流量以及并发症发生率；观察术前及术后1周、6个月、1年的视觉模拟评分（visual analogue scale，VAS），腰椎日本骨科协会（Japanese Orthopaedic Association，JOA）评分和Oswestry功能障碍指数（Oswestry Disability Index，ODI）。结果：37例患者手术时间为78~171（120.74±41.19）min；术中出血量为61~102（85.26±25.44）ml；术后引流量为35~98（40.75±12.17）ml。8例患者出现并发症，其中神经损伤2例，疼痛加重4例，内固定松动1例，椎间隙不融合1例。患者术后1周、6个月、1年VAS、JOA评分和ODI较术前均有明显改善（P<0.05）。结论：PE-TLIF治疗L₅S₁椎间盘突出症具有术中出血量少、创伤小、近期疗效满意等优点，可以有效改善患者症状，但在实际临床中并发症发生率较高，需严格把握手术适应证。

Percutaneous endoscopic translaminar lumbar interbody fusion for the treatment of L5S1 intervertebral disc herniation

Objective: To observe the effeicacy and safety of percutaneous endoscopic translaminar lumbar interbody fusion(PE-TLIF) in the treatment of L₅S₁ intervertebral disc herniation.Methods: The clinical data of 37 patients with L₅S₁ intervertebral disc herniation underwent PE-TLIF from January 2018 to December 2019 were retrospectively analyzed. There were 16 males and 21 females, aged from 30 to 68 years old, with a mean of(45.62±13.57) years;body mass index was from 19.5 to 28.8 kg/m², with a mean of (24.33±3.51) kg/m²;the course of disease was from 18 to 48 months, with a mean of(27.18±6.65) months. Operation time, intraoperative blood loss, postoperative drainage and complication rate were recorded;visual analogue scale(VAS), Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index(ODI) before operation, 1 week, 6 months, 1 year after operation were observed.Results: The operation time ranged from 78 to 171 min, with a mean of (120.74±41.19) min;intraoperative blood loss ranged from 61 to 102 ml, with a mean of (85.26±25.44) ml;and postoperative drainage ranged from 35 to 98 ml, with a mean of(40.75±12.17) ml. Complications occurred in 8 patients, including 2 cases of nerve injury, 4 cases of pain aggravated, 1 case of internal fixation loosening, and 1 case of intervertebral space nonfusion. The VAS, JOA score and ODI significantly improved after 1 week, 6 months, and 1 year after operation (P<0.05).Conclusion: PE-TLIF for the treatment of L₅S₁ intervertebral disc herniation has the advantages of less intraoperative blood loss, less trauma, and satisfactory short-term curative effect. It can effectively improve the symptoms of patients. However, the incidence of complications in the actual clinical practice is frequent, and surgical indications need to be strictly grasped.