Kong Weijun, Liao Wenbo, Ao Jun, Cao Guangru, Qin Jianpu, Cai Yuqiang
Department of Spine Surgery, The First Affiliated Hospital of Zunyi Medical College, Zunyi 563000, China.
Biomed Res Int. 2016;2016:4702946. doi: 10.1155/2016/4702946. Epub 2016 Aug 25.
Objective is to analyze the surgical strategy, safety, and clinical results of percutaneous full-endoscopic discectomy through interlaminar or extraforaminal puncture technique for LDH. Preoperative CT and MRI were analyzed, which were based on the main location of the herniated disc and its relationship with compressed nerve root. Sixty-two patients satisfied the inclusion criteria during the period from August 2012 to March 2014. We use percutaneous full-endoscopic discectomy through different puncture technique to remove the protrusive NP for LDH. Sixty patients completed the full-endoscopic operation successfully. Their removed disc tissue volume ranged from 1.5 mL to 3.8 mL each time. Postoperative ODI and VAS of low back and sciatica pain were significantly decreased in each time point compared to preoperative ones. No nerve root injury, infection, and other complications occurred. The other two patients were shifted to open surgery. No secondary surgery was required and 91.6% of excellent-to-good ratio was achieved on the basis of Macnab criteria at postoperative 12 months. Acquired benefits are fewer complications, rapid recovery, complete NP removal, effective nerve root decompression, and satisfactory cosmetic effect as well. This is a safe, effective, and rational minimally invasive spine-surgical technology with excellent clinical outcome.
目的是分析经皮全内镜下经椎板间或椎间孔外穿刺技术治疗腰椎间盘突出症(LDH)的手术策略、安全性及临床效果。基于椎间盘突出的主要位置及其与受压神经根的关系,对术前CT和MRI进行分析。2012年8月至2014年3月期间,62例患者符合纳入标准。我们采用经皮全内镜下不同穿刺技术切除突出的髓核治疗LDH。60例患者成功完成全内镜手术。每次切除的椎间盘组织体积为1.5毫升至3.8毫升。与术前相比,术后各时间点的腰椎功能障碍指数(ODI)以及腰腿痛和坐骨神经痛的视觉模拟评分(VAS)均显著降低。未发生神经根损伤、感染及其他并发症。另外2例患者转为开放手术。术后12个月,基于Macnab标准,无需二次手术,优良率达91.6%。该手术还具有并发症少、恢复快、髓核完全切除、神经根有效减压及美容效果满意等优点。这是一种安全、有效且合理的微创脊柱手术技术,临床效果优良。