一次破开黄韧带与内窥镜下分步破开黄韧带经皮内窥镜下腰椎椎间盘切除术治疗L5/S1椎间盘突出症

目的比较一次破开黄韧带与内窥镜下分步破开黄韧带经椎板间入路经皮内窥镜下腰椎椎间盘切除术(PEID)治疗L5/S1椎间盘突出症的临床疗效和安全性。方法回顾性分析2017年5月—2018年9月接受PEID治疗的63例L5/S1椎间盘突出症患者的病例资料,其中28例术中一次破开黄韧带(A组),35例术中在内窥镜下分步破开黄韧带(B组)。比较2组手术时间、透视次数、住院时间、疗效及并发症发生情况。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评价疗效。结果所有患者随访时间超过16个月,随访期间无复发病例。A组手术时间短于B组,透视次数多于B组,差异均有统计学意义(P<0.05)。2组住院时间差异无统计学意义(P>0.05)。2组术后腰腿痛VAS评分及ODI与术前相比均明显改善,差异有统计学意义(P<0.05),但组间各时间点相比,差异均无统计学意义(P>0.05)。A组中有23例(82.1%)、B组中有27例(77.1%)术后出现下肢局部麻木感,组间比较差异无统计学意义(P>0.05)。B组1例术后出现小腿后侧麻木感较术前加重并伴有刺痛,考虑为S1神经根损伤,经糖皮质激素、神经营养药物等治疗后康复。结论2种术式均安全有效,在合适的手术适应证下,一次破开黄韧带的手术时间更短,应优先选用;若患者不能耐受或适应证不满足,可选择内窥镜下分步破开黄韧带。

Percutaneous endoscopic interlaminar discectomy for L5/S1 disc herniation by breaking ligamentum flavum at one-time or clipping ligamentum flavum step-by-step under endoscopy

Objective To compare the clinical efficacy and safety of percutaneous endoscopic interlaminar discectomy(PEID)for L5/S1 disc herniation by breaking the ligamentum flavum at one-time or clipping the ligamentum flavum step-by-step under endoscopy.Methods From May 2017 to September 2018,63 patients with L5/S1 disc herniation treated by PEID were included in this retrospective study.Among them,28 cases were treated by breaking the ligamentum flavum at one-time(group A),and 35 cases by clipping the ligamentum flavum step-by-step under endoscopy(group B).The operation time,fluoroscopy frequency,hospital stay,effects and complications were compared between the 2 groups.The clinical efficacy was evaluated by visual analogue scale(VAS)score and Oswestry disability index(ODI).Results All the patients were followed up for more than 16 months,and there was no recurrence during the follow-up period.The operation time of group A was shorter than those of group B,and the fluoroscopy frequency were more than that of group B,and all with a statistical significance(P<0.05).There was no significant difference in hospital stay between the 2 groups(P>0.05).The VAS scores of low back pain and leg pain and ODI in the 2 groups were significantly improved compared with those before operation,with a statistical significance(P<0.05),but there was no significant difference between the 2 groups at each time point(P>0.05).There were 23 cases(82.1%)in group A and 27(77.1%)in group B with local numbness in lower extremity after operation,with no statistical difference(P>0.05).In group B,1 case showed increased posterior leg numbness and tingling after surgery compared with that before surgery,which was considered as S1 nerve root injury and recovered after glucocorticoid and nerve nutrition treatment.Conclusion The two methods are both safe and effective.Under the appropriate indications,the operation time of breaking the ligamentum flavum at one-time is shorter,should be applied preferentially.If the indications do not meet or the patient cannot tolerate the procedure,clipping the ligamentum flavum step-by-step under endoscopy can be chosen.