单侧双通道内镜治疗重度脱垂型腰椎间盘突出症

Unilateral biportal endoscopy for far-migrated lumbar intervertebral disc herniation

摘要:

[目的]评价单侧双通道内镜治疗重度脱垂型腰椎间盘突出症的临床疗效。[方法]2020 年 4 月—2020 年 12 月，在本科行单侧双通道内镜治疗的重度脱垂型腰椎间盘突出症患者 19 例。总结围手术期、随访与影像学结果。[结果]所有患者手术均顺利完成，无严重并发症，手术时间 (75.37±13.62) min，出血量 (61.84±20.45) ml，透视次数 (2.84±0.83) 次。术后患者腰部及下肢 VAS 评分显著持续下降(P＜0.05)，至术后 30 d 患者疼痛基本消失。随时间推移，患者改良 ODI 评分显著下降， 而 JOA 评分显著增加 (P＜0.05)。按改良 Macnab 标准，末次随访时的临床疗效：优 16 例，良 2 例，可 1 例，优良率 94.74%。 至末次随访时，MRI 显示手术节段无突出复发。[结论]单侧双通道内镜是治疗重度脱垂型腰椎间盘突出症的有效方法。

Abstract:

[Objective] To explore the clinical efficacy of unilateral biportal endoscopy for far-migrated lumbar intervertebral disc her- niation. [Methods] From April 2020 to December 2020, 19 patients underwent unilateral biportal endoscopy for far-migrated lumbar inter- vertebral disc herniation in our department. The documents of perioperative period, follow-up and radiographic results were summarized. [Results] All patients had operation completed successfully without serious complications, while with operation time of (75.37±13.62) min, blood loss of (61.84±20.45) ml, and times of fluoroscopy of (2.84±0.83) . The VAS score for lower back pain and leg pain continued to de- crease significantly after the operation (P＜0.05) , and the pain almost disappeared by 30 days after the operation. The modified ODI score decreased significantly, while the JOA score increased significantly over time (P＜0.05) . Based on Modified Macnab criterion, the clinical outcomes were marked as excellent in 16 cases, good in 2 cases and fair in 1 case with excellent and good rate of 94.74%. At the latest fol- low-up, MRI showed far-migrated lumbar intervertebral discs were successfully removed without recrudescence. [Conclusion] Unilateral biportal endoscopy is an effective method for treatment of far-migrated lumbar intervertebral disc herniation.