Hua Wenbin, Zhang Yukun, Wu Xinghuo, Gao Yong, Li Shuai, Wang Kun, 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 Nov;97(48):e13456. doi: 10.1097/MD.0000000000013456.
The purpose of this retrospective study was to assess the clinical outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar approach versus the transforaminal approach under general anesthesia in the treatment of L5-S1 disc herniation.Sixty patients with L5-S1 disc herniation were non-randomly recruited and assigned into two groups. One group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the interlaminar approach under general anesthesia, while the other group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the transforaminal approach under general anesthesia. The operative time, fluoroscopy time, and perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 18 months postoperatively.The mean operative time and fluoroscopy time in the interlaminar group were significantly shorter compared with those in the transforaminal group. The mean VAS and ODI postoperative scores were significantly improved over the preoperative scores in both groups. According to the MacNab classification system, more than 90.0% of the patients achieved an excellence/good rating in both groups. An intraoperative epineurium injury occurred in both groups. The total recurrence rate during 18 months follow-up was 3.3% in the interlaminar group and 0% in the transforaminal group.It is efficient and safe to perform discectomy by using full-endoscopic visualization technique via both interlaminar and transforaminal approaches under general anesthesia in patients with L5-S1 disc herniation. Discectomy performed by using full-endoscopic visualization technique via the interlaminar approach requires a shorter operative time and suffers less radiation exposure than the transforaminal approach.
本回顾性研究的目的是评估在全身麻醉下，采用全内镜可视化技术经椎板间入路与经椎间孔入路行椎间盘切除术治疗L5-S1椎间盘突出症的临床疗效。60例L5-S1椎间盘突出症患者被非随机招募并分为两组。一组（30例患者）在全身麻醉下采用全内镜可视化技术经椎板间入路行椎间盘切除术，另一组（30例患者）在全身麻醉下采用全内镜可视化技术经椎间孔入路行椎间盘切除术。记录手术时间、透视时间和围手术期并发症。术前及术后3个月、6个月和18个月评估腿痛和背痛的视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI）评分。椎板间组的平均手术时间和透视时间明显短于椎间孔组。两组术后VAS和ODI评分均较术前明显改善。根据MacNab分类系统，两组中超过90.0%的患者获得了优/良评级。两组均发生术中神经外膜损伤。椎板间组18个月随访期间的总复发率为3.3%，椎间孔组为0%。在全身麻醉下，采用全内镜可视化技术经椎板间和椎间孔入路对L5-S1椎间盘突出症患者行椎间盘切除术是有效且安全的。与经椎间孔入路相比，采用全内镜可视化技术经椎板间入路行椎间盘切除术所需手术时间更短，辐射暴露更少。
