全内镜下腰椎纤维环缝合术的技术要点及临床疗效分析

目的 :介绍全内镜下腰椎纤维环缝合术的技术要点,分析全内镜下腰椎间盘摘除、纤维环缝合术的临床疗效。方法:纳入2018年1月至2018年11月采用全内镜下腰椎间盘摘除、纤维环缝合术治疗的50例非包含型腰椎间盘突出症患者,根据病变节段选择经椎间孔入路全内镜下单针缝合术或经椎板间隙入路双针缝合术。术后第2天、3个月分别复查腰椎MRI及CT以评估突出椎间盘组织摘除的彻底性及神经减压的充分性。分别于术后第2天及3、6、12个月采用视觉模拟评分(visual analogue scale,VAS,100分制)评估患者疼痛症状缓解情况,于术后3、6、12个月采用Oswestry功能障碍指数(Oswestry Disability Index,ODI)评价患者腰椎功能恢复情况,术后1年随访时采用Macnab评定标准评估腰椎功能,记录神经根功能(感觉、肌力及反射)恢复状况。结果:所有手术顺利完成,采用经椎间孔入路27例(包括L_3,48例、L_4,519例),经椎板间隙入路23例(包括L_4,511例、L₅S_1<...

Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture

Objective: To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture.Methods: A total of 50 patients with non-contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day,3 months,6 months,and 1 year after surgery for pain relief using visual analogue scale(VAS,100-point scale). The patients were followed up at 3 months,6 months,and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up,the Macnab standard of lumbar spine function was evaluated,and the recovery of nerve root function (sensory,muscular and reflex) was recorded.Results: All operations were successfully completed,of which 27 patients were treated with transforaminal approach(including 8 cases of L_3,4 and 19 cases of L_4,5),and 23 patients(including 11 cases of L_4,5 and 12 cases of L₅S₁) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain,and the ODI score improved significantly(P<0.01). At 1 year postoperative follow-up,17 patients got an excellent result,29 good and 4 fair according to Macnab evaluation system. On the first year after surgery,the sense of damaged nerve roots and muscle strength were significantly restored (P<0.01),but tendon reflexes were not significantly restored (P>0.05).Conclusion: Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery,which can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy.