CT引导保留黄韧带椎板间入路脊柱内镜手术治疗腰4/ 5椎间盘突出症的探讨*

CT-guided ligamentum-sparing percutaneous endoscopicSinterlaminarSdiscectomy in the treatment of L4/5 lumbar disc herniationZhong qiong, Yang jun, Ran bing, Chen xin-rong, Liu yong, Fu min, Wu yun, Deng xin, Wen xin-yuan, Wei jun△

摘要:

目的：探讨CT引导保留黄韧带椎板间入路脊柱内镜手术（percutaneous endoscopic interlaminar discectomy PEID）治疗腰4/5椎间盘突出症的疗效及安全性。方法：纳入2016年1月至2018年12月在我科行CT引导保留黄韧带PEID的腰4/5椎间盘突出症患者102例，随访评估术前、术后1天、术后1周、术后1月、术后3月及术后6月的VAS评分、腰椎ODI指数及改良Macnab评分，记录患者手术并发症及复发率。结果：患者术后VAS评分明显下降趋势(P＜0.01 )；术后ODI指数明显下降趋势(P＜0.001)，术后6月MacNab标准评定提示优良率为97.1%（优91例，良8例，差3例），部分患者术后残留轻中度腰痛及下肢痛，极少数有神经病理性痛表现。结论：在掌握适应证情况下，CT引导下保留黄韧带PEID技术为腰4/5椎间盘突出症提供了安全、有效的方法。

Abstract:

Objective To investigate the clinic efficacy and safey of CT-PEID，in premise of ligament-sparing, in the treatment of L4/5 lumbar disc herniation. Methods From January 2016 to December 2018, 102 patients with L4/5 lumbar disc herniation were included in this investigation and obtained the CT-PEID of retaining ligamentum flavum. The pain relieve was evaluated by Visual Analogue Scale (VAS) by each preoperation and postoperation time point, Oswestry Disability Index (ODI) and modified Macnab criteria were used to evaluate the lumbar function before surgery and follow periods.The surgery complication and recurrent rate also been recoded. Results A significant decrease in postoperative VAS scores(p<0.01). A significant decrease in postoperative ODI index(p<0.01). According to the MacNab criteria, 91 patients have achieved excellent, 8 patients were well and 3 patients were unsatisfied at 6 months post-operation.Some patients had mild and moderate back pain and lower limb pain after operation, and very few had neuropathic pain. Conclusion CT-PEID of retaining ligamentum flavum is a safe and minimally procedure for L4/5 lumbar disc herniation patients.