Li Zhen-Zhou, Cao Zheng, Zhao Hong-Liang, Shang Wei-Lin, Hou Shu-Xun
Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China.
Zhongguo Gu Shang. 2020 Jun 25;33(6):498-504. doi: 10.12200/j.issn.1003-0034.2020.06.002.
To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture.
A total of 50 patients with non contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day, 3 months, 6 months, and 1 year after surgery for pain relief using visual analogue scale (VAS, 100 -point scale). The patients were followed up at 3 months, 6 months, and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up, the Macnab standard of lumbar spine function was evaluated, and the recovery of nerve root function (sensory, muscular and reflex) was recorded.
All operations were successfully completed, of which 27 patients were treated with transforaminal approach(including 8 cases of L and 19 cases of L), and 23 patients(including 11 cases of L and 12 cases of LS) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerveswere fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain, and the ODI score improved significantly(<0.01). At 1 year postoperative follow up, 17 patients got an excellent result, 29 good and 4 fair according to Macnab evaluation system. On the first year after surgery, the sense of damaged nerve roots and muscle strength were significantly restored (<0.01), but tendon reflexes were not significantly restored (>0.05).
Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery, which can reduce the recurrence rate of lumbar disc herniation after full endoscopic lumbar discectomy.
介绍全内镜下腰椎纤维环缝合的技术要点，并分析全内镜下腰椎间盘切除术联合纤维环缝合的临床疗效。
纳入2018年1月至2018年11月在我科接受全内镜下腰椎间盘切除术联合纤维环缝合治疗的50例非包容性腰椎间盘突出症患者。根据病变节段选择经椎间孔入路全内镜单针缝合或经椎板间入路双针缝合。分别于术后第2天和3个月复查腰椎MRI和CT，评估椎间盘切除的完整性和神经减压的充分性。术后第2天、3个月、6个月和1年采用视觉模拟评分法（VAS，100分制）对患者进行随访，观察疼痛缓解情况。术后3个月、6个月和1年采用Oswestry功能障碍指数（ODI）对患者进行随访，观察腰椎功能恢复情况。术后1年采用Macnab腰椎功能标准进行评估，记录神经根功能（感觉、肌肉和反射）的恢复情况。
所有手术均顺利完成，其中经椎间孔入路27例（L45 8例，L5S1 19例），经椎板间入路23例（L45 11例，L5S1 12例）。平均手术时间为43.2分钟。无手术并发症发生，无腰椎间盘突出症复发。所有患者术后腰椎MRI和CT检查显示突出椎间盘完全切除，神经充分减压。所有患者腰背痛及下肢放射痛均明显缓解，ODI评分显著改善（P<0.01）。术后1年随访，根据Macnab评估系统，优17例，良29例，可4例。术后1年，受损神经根感觉及肌力明显恢复（P<0.01），但腱反射恢复不明显（P>0.05）。
全内镜下腰椎间盘切除术联合纤维环缝合是一种安全有效的微创脊柱手术技术，可降低全内镜下腰椎间盘切除术后腰椎间盘突出症的复发率。
