经皮椎间孔内镜下腰椎间盘切除术治疗 L5/S1 远外侧型椎间盘突出症：术中 CT 辅助。

Percutaneous Endoscopic Discectomy Via a Transforaminal Approach for L5/S1 Far-Lateral Disc Herniation Assisted by Intraoperative Computed Tomography.

机构信息

Suzhou Medical College of Soochow University, Suzhou, China; Pain Department, GanNan Medical University, GanZhou, China; First Affiliated Hospital of GanNan Medical University, GanZhou, China.

Pain Department, GanNan Medical University, GanZhou, China; First Affiliated Hospital of GanNan Medical University, GanZhou, China.

出版信息

World Neurosurg. 2022 Oct;166:e823-e831. doi: 10.1016/j.wneu.2022.07.103. Epub 2022 Aug 1.

DOI:10.1016/j.wneu.2022.07.103

PMID:35926700

Abstract

OBJECTIVE

To examine the clinical outcomes of a percutaneous lumbar transforaminal endoscopic discectomy (PTED) with intraoperative computed tomography (iCT) navigation for the treatment of L5-S1 far-lateral lumbar disc herniation (LDH).

METHODS

A total of 30 patients with L5-S1 far-lateral LDH who underwent PTED with iCT navigation from September 2016 to October 2020 were enrolled in this study. Outcomes were assessed using the visual analog scale pain score, the Oswestry Disability Index, the Japanese Orthopedic Association score, the EQ-5D-5 L and the modified Macnab criteria. Preoperative and postoperative complications were recorded.

RESULTS

The mean visual analog scale score for leg pain improved from 8.1 at baseline to 2.3, 0.9, 0.7 and 0.9 at 1 day, 1 week, 6 months, and 12 months postoperatively, respectively (P < 0.01). The mean Oswestry Disability Index improved from 78.1% at baseline to 45.5%, 21.9%, 12.6%, and 11.7% at 1 week, 1 month, 6 months, and 12 months postoperatively, respectively (P < 0.01); and the mean Japanese Orthopedic Association score improved from 8.6 at baseline to 14.2, 20.2, 24.4, and 25.6 at 1 day, 1 week, 6 months, and 12 months postoperatively, respectively (P < 0.01). At 12 months postoperatively, the EQ-5D-5 L value significantly increased, from -0.061 ± 0.138 to 0.903 ± 0.064. The rate of a good or excellent modified Macnab result was 93% (26/28) at 12 months postoperatively. In the present study, combined L5-S1 foraminal stenosis tended to lead poor outcomes, which required more postsurgical treatments.

CONCLUSIONS

With iCT navigation, PTED is a feasible and effective minimally invasive surgery for L5-S1 far-lateral LDH.

摘要

目的

探讨术中计算机断层扫描（iCT）导航下经皮椎间孔腰椎内窥镜椎间盘切除术（PTED）治疗 L5-S1 远外侧腰椎间盘突出症（LDH）的临床效果。

方法

回顾性分析 2016 年 9 月至 2020 年 10 月期间，30 例接受 iCT 导航下 PTED 治疗的 L5-S1 远外侧 LDH 患者的临床资料。采用视觉模拟评分法（VAS）、Oswestry 功能障碍指数（ODI）、日本骨科协会（JOA）评分、EQ-5D-5L 量表和改良 Macnab 标准评估疗效，记录术前、术后并发症发生情况。

结果

术后 1 天、1 周、6 个月和 12 个月，患者腿痛 VAS 评分分别由术前的 8.1 分改善至 2.3、0.9、0.7 和 0.9 分（P<0.01）；ODI 分别由术前的 78.1%改善至 45.5%、21.9%、12.6%和 11.7%（P<0.01）；JOA 评分分别由术前的 8.6 分改善至 14.2、20.2、24.4 和 25.6 分（P<0.01）。术后 12 个月，EQ-5D-5L 评分由术前的-0.061±0.138 显著升高至 0.903±0.064（P<0.01）。术后 12 个月，改良 Macnab 疗效评定优良率为 93%（26/28）。本研究中，合并 L5-S1 椎间孔狭窄者术后疗效较差，需进一步治疗。