Hua Wenbin, Tu Ji, Li Shuai, Wu Xinghuo, Zhang Yukun, Gao Yong, Zeng Xianlin, Yang Shuhua, Yang Cao
Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2018 Apr;97(17):e0585. doi: 10.1097/MD.0000000000010585.
The purpose of this retrospective study was to investigate the clinical outcomes of full-endoscopic discectomy via the interlaminar approach in the treatment of lumbar disc herniation (LDH) at L4-L5 under general anesthesia.Eighty-four patients who underwent full-endoscopic discectomy via the interlaminar approach at L4-L5 or L5-S1 were included. Durations of surgery, intraoperative radiation, postoperative bedrest, and hospitalization as well as perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and the Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 12 months postoperatively.The mean durations of surgeries in surgeries involving L4-L5 and L5-S1 were 69.8 ± 18.8 and 67.0 ± 20.1 minutes, respectively. The mean durations of intraoperative radiation were 1.2 ± 0.3 and 1.3 ± 0.3 seconds, respectively. The mean VAS and ODI scores improved significantly postoperatively compared with the preoperative scores. The perioperative complications included intraoperative epineurium injury in 3 cases without nerve injury, cerebrospinal fluid leakage, or cauda equina syndrome. The total recurrence rate after 12 months follow-up was 1.2% (one case at L5-S1).Full-endoscopic discectomy via the interlaminar approach could be considered as one of the alternative options for the treatment of LDH at L4-L5.
本回顾性研究的目的是探讨在全身麻醉下，经椎间孔全内镜下椎间盘切除术治疗L4-L5节段腰椎间盘突出症（LDH）的临床疗效。纳入84例行L4-L5或L5-S1节段经椎间孔全内镜下椎间盘切除术的患者。记录手术时间、术中透视时间、术后卧床时间、住院时间以及围手术期并发症。术前及术后3、6和12个月评估腿痛和背痛的视觉模拟量表（VAS）评分以及Oswestry功能障碍指数（ODI）评分。涉及L4-L5和L5-S1手术的平均手术时间分别为69.8±18.8分钟和67.0±20.1分钟。术中透视的平均时间分别为1.2±0.3秒和1.3±0.3秒。与术前评分相比，术后VAS和ODI评分均显著改善。围手术期并发症包括3例术中出现神经外膜损伤，但无神经损伤、脑脊液漏或马尾综合征。随访12个月后的总复发率为1.2%（L5-S1节段1例）。经椎间孔全内镜下椎间盘切除术可被视为治疗L4-L5节段LDH的替代选择之一。
