摘要
目的比较经椎板间和椎间孔两种不同入路全内窥镜脊柱手术治疗L5-S1水平椎间盘突出的术后疗效。方法回顾性分析2019年10月—2020年10月在本院接受全内窥镜脊柱手术治疗L5-S1节段椎间盘突出的61例患者的临床资料,根据手术方式不同分为椎间孔入路组(TF-FESS组,28例)和椎板间入路组(IL-FESS组,33例)两组。采用VAS评分和ODI指数比较术后两种术式的术后疗效。结果两组患者均顺利完成手术。两组年龄、BMI、住院时间、术中出血、L5-S1椎间盘突出方向和是否有慢性疾病组间比较,差异无统计学意义(P>0.05)。两组组间手术时间、术中透视次数、性别和麻醉方式比较,差异有统计学意义(P<0.01)。两组VAS评分、ODI指数术后6周,术后6个月,末次随访组内与术前相比均明显降低,差异有统计学意义(P<0.05);但两组VAS评分、ODI指数组间比较,差异无统计学意义(P>0.05)。在IL-FESS组,1例患者出现部分马尾神经损伤导致的排便障碍的症状,经激素、营养神经和止痛药物联合治疗后症状在术后1周改善,恢复自主排尿。TF-FESS组1例术后出现髓核残留症状,进行了第二次IL-FESS手术,术后恢复较好。结论与TF-FESS相比,IL-FESS能明显缩短手术时间、减少术中透视次数,但两种手术入路均是治疗LDH安全有效的手术方式。IL-FESS治疗男性LDH患者有着较好的术后疗效和较简单的术中操作。在临床工作中,应根据患者LDH椎间盘突出位置或其他生理结构综合考虑选择合适的手术方法。手术医生应熟练掌握两种手术入路的解剖以及适应证,根据自身情况和患者条件选择合适的手术方案。
Objective To compare the clinical efficacy of full-endoscopic spinal surgery through interlaminar and transforaminal approaches in treating L5-S1 segmental disc herniation.Methods A retrospective analysis was conducted on the clinical data of 61 patients undergoing full-endoscopic spinal surgery for L5-S1 segment disc herniation in the hospital from October 2019 to October 2020.The patients were divided into transforaminal full-endoscopic spinal surgery group(TF-FESS group,n=28)and interlaminar full-endoscopic spinal surgery group(IL-FESS group,n=33)according to different surgery approaches.And the VAS score and ODI index were used to compare the clinical efficacy of the two surgical methods.Results All patients successfully completed the operation.There was no statistical difference between groups in age,BMI,hospitalization,intraoperative bleeding,L5-S1disc herniation direction,and chronic disease history(P>0.05).There were statistical difference in surgical time,intraoperative perspective time,gender and anesthesia between the two groups(P<0.01).Compared with those before treatment,both the VAS score and ODI index of the two groups were significantly decreased at time points 6 weeks,6 months after surgery and at final follow up(P<0.05).However,the difference in VAS scores and ODI index were not statistically significant between the two groups(P>0.05).And one patient developed symptoms of defecation disorder caused by partial cauda equina injury in the IL-FESS group.Symptoms improved 1 week after treatment with hormone,neurotrophic and analgesic drugs and returned to spontaneous urination.The residual symptoms of nucleus pulposus appeared in one case of TF-FESS group,and the second IL-FESS operation was carried out,and the postoperative recovery was better.Conclusions IL-FESS could significantly shorten the operation time and reduce the number of fluoroscopy,but both surgical approaches are safe and effective for LDH treatment.IL-FESS treatment of male LDH patients has better postoperative efficacy and simple in
作者
吴仲宣
徐宏光
赵泉来
肖良
刘晨
侯坤鹏
Wu Zhongxuan;Xu Hongguang;Zhao Quanlai;Xiao Liang;Liu Cheng;Hou Kunpeng(Spinal surgery research center of Wannan Medical College&Department of spinal surgery,Yijishan hospital/first affiliated hospital of Wannan Medical College,Wuhu,241001,Anhui,China)
出处
《齐齐哈尔医学院学报》
2022年第5期428-432,共5页
Journal of Qiqihar Medical University
基金
国家自然科学基金面上项目(81972108)
皖南医学院弋矶山医院科技创新团队“攀峰”培育计划(腰椎退行性疾病微创团队)(PF20190073)
皖南医学院弋矶山医院科研能力“高峰”培育计划项目(GF2019T02,GF2019G07,GF2019G12)。
