脊柱内窥镜下治疗极外侧型腰椎间盘突出症的临床疗效探讨

摘要

Objective To analyze the clinical efficacy of spinal endoscopic technique for extreme lateral lumbar disc herniation. Methods Thirty⁃two patients with extreme lateral disc herniation treated by percutaneous endoscopic spine surgery were collected. The patients were assessed by visual analogue scale (VAS) score and Oswestry disability index (ODI) at 1st day, 1st week, 3rd month and 6th month. The Macnab criteria were used to evaluate the clinical efficacy. Results There were no complications such as vascular nerve injury. The operation time of single section was 20 min (10⁃35 min), the hospital stay was 5 days (3⁃7 days). During the follow⁃up periods of 1 day, 1 week, 3 months, and 6 months post⁃surgery, the VAS scores were 2.53±0.61, 1.50±0.43, 1.48±0.35, and 1.47±0.31 respectively, significantly lower than be⁃fore surgery (8.81±0.42, all P<0.05). The ODI at 1st day, 1st week, 3rd month, and 6th month post⁃surgery were (18.01 ± 6.42)%, (17.54 ± 5.53)%, (16.33 ± 6.42)%, and (16.04 ± 6.51)% respectively, significantly lower than before surgery [(76.51 ± 13.25)%, all P<0.05]. Excellent and good rate was 93.75% according to Macnab (19 in excellent, 9 in good, and 2 in fair). Conclusion Percutaneous endoscopic technique via the spinal lateral approach for extreme lateral lumbar disc herniation has the advantages of shorter operative time, less trauma, quicker recovery and better curative effectiveness.%目的：探讨侧路脊柱内窥镜下治疗极外侧型腰椎间盘突出症的临床疗效。方法采用经皮脊柱内窥镜侧路手术治疗极外侧型椎间盘突出症患者32例，分别于术后1 d、1周、3个月、6个月采用疼痛视觉模拟量表（visual analogue scale, VAS）评分和Oswestry功能障碍指数（Oswestry disability index, ODI）评价疼痛及功能障碍情况，末次随访时采用Macnab标准评价临床疗效。结果术中未出现血管神经损伤等并发症，单节手术时间为20 min（10~35 min），住院时间为5 d（3~7 d）。随访1 d、1周、3个月、6个月时的VAS评分分别为（2.53±0.61）分、（1.50±0.43）分、（1.48±0.35）分、（1.47±0.31）分，与术前的（8.81±0.42）分相比，差异均有统计学意义（均P＜0.05）；随访1 d、1周、3个月、6个月时的ODI分别为（18.01±6.42）%、（17.54±5.53）%、（16.33±6.42）%、（16.04±6.51）%，与术前的（76.51±13.25）%相比，差异均有统计学意义（均P＜0.05）。Macnab疗效评定结果，优19例，良11例，可2例，优良率为93.75%。结论经皮侧路脊柱内窥镜治疗极外侧型腰椎间盘突出症具有手术时间短、创伤小、恢复快等优点，疗效确切。