过屈跪位与俯卧位下L4/L5椎板间隙形态差异及其在经椎板间入路经皮内窥镜下椎间盘切除术治疗腰椎椎间盘突出症中的意义

摘要

Objective To measure the height and width of the L4/L5interlaminar space in flexion kneeling position under general anesthesia,and explore the significance in percutaneous endoscopic interlaminar discectomy(PEID) for lumbar disc herniation(LDH). Methods From April 2014 to June 2016,81 L4/L5LDH patients were treated by PEID,41 in the flexion kneeling position(flexion kneeling position group) and 40 in the prone position(prone position group). The height and width of the L4/L5interlaminar space during the operation were measured by C-arm X-ray machine,and the data were compared between the 2 groups. The leg pain and low back pain visual analogue scale(VAS) scores and Oswestry disability index(ODI) were recorded before and after the operation in all patients to evaluate the therapeutic effect. Results All the patients were successfully operated and followed up for > 6 months. The height of L4/L5interlaminar space in flexion kneeling position group was higher than that in prone position group,and the difference was statistically significant(P < 0.05). There was no significant difference in width of L4/L5interlaminar space between the 2 groups(P > 0.05). Leg pain and low back pain were significantly relieved in all the patients. The leg pain and low back pain VAS scores and ODI of all patients were significantly improved compared with those before operation. Conclusion The flexion kneeling position of the patients can significantly reduce the curvature of the lumbar spine,and increase the height of the interlaminar space,and increase the mobility and operating space of the percutaneous endoscopic system working channel in the spinal canal,and reduce the bony resection of the laminae. It is safe and effective perform PEID in flexion kneeling position for LDH.%目的 测量患者全麻后过屈跪位下L4/L5椎板间隙高度和宽度,探讨其在过屈跪位下行经椎板间入路经皮内窥镜下椎间盘切除术(PEID)治疗L4/L5腰椎椎间盘突出症(LDH)中的意义. 方法 2014年4月—2016年6月,采用PEID治疗L4/L5LDH患者81例,手术体位为过屈跪位41例(过屈跪位组),俯卧位40例(俯卧位组).用C形臂X线机正位透视测量患者摆好手术体位后L4/L5椎板间隙的高度和宽度,并进行组间比较.记录所有患者手术前后下肢痛、腰痛疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI),评价手术疗效. 结果 所有患者手术均顺利完成,随访> 6个月.过屈跪位组L4/L5椎板间隙高度大于俯卧位组,差异有统计学意义(P < 0.05);2组L4/L5椎板间隙宽度差异无显著统计学意义(P > 0.05).所有患者术后下肢痛和腰痛明显缓解,所有患者下肢痛、腰痛VAS评分及ODI均较术前显著改善. 结论 患者在过屈跪位下可显著减小腰椎曲度、增加椎板间隙高度,使经皮内窥镜系统工作通道在椎管内的活动度及安全操作空间增加,减少椎板骨质切除.过屈跪位下行PEID治疗L4/L5LDH安全、有效.