全内镜下腰椎纤维环缝合术的技术要点及临床疗效分析
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作者Author单位AddressE-Mail
李振宙 LI Zhen-zhou 解放军总医院第四医学中心骨科, 北京 100048 Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China dr_lizhenzhou@163.com 
曹峥 CAO Zheng 解放军总医院第四医学中心骨科, 北京 100048 Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China  
赵宏亮 ZHAO Hong-liang 解放军总医院第四医学中心骨科, 北京 100048 Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China  
商卫林 SHANG Wei-lin 解放军总医院第四医学中心骨科, 北京 100048 Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China  
侯树勋 HOU Shu-xun 解放军总医院第四医学中心骨科, 北京 100048 Department of Orthopaedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China  
期刊信息:《中国骨伤》2020年,第33卷,第6期,第498-504页
DOI:10.12200/j.issn.1003-0034.2020.06.002
基金项目:
中文摘要:

目的:介绍全内镜下腰椎纤维环缝合术的技术要点,分析全内镜下腰椎间盘摘除、纤维环缝合术的临床疗效。

方法:纳入2018年1月至2018年11月采用全内镜下腰椎间盘摘除、纤维环缝合术治疗的50例非包含型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下单针缝合术或经椎板间隙入路双针缝合术。术后第2天、3个月分别复查腰椎MRI及CT以评估突出椎间盘组织摘除的彻底性及神经减压的充分性。分别于术后第2天及3、6、12个月采用视觉模拟评分(visual analogue scale,VAS,100分制)评估患者疼痛症状缓解情况,于术后3、6、12个月采用Oswestry功能障碍指数(Oswestry Disability Index,ODI)评价患者腰椎功能恢复情况,术后1年随访时采用Macnab评定标准评估腰椎功能,记录神经根功能(感觉、肌力及反射)恢复状况。

结果:所有手术顺利完成,采用经椎间孔入路27例(包括L3,4 8例、L4,5 19例),经椎板间隙入路23例(包括L4,5 11例、L5S1 12例)。手术时间平均43.2 min。无手术并发症发生,无腰椎间盘突出复发。所有患者术后腰椎MRI及CT检查显示突出椎间盘摘除完全、神经减压充分,无突出物残留。所有患者术后腰痛、下肢放射痛明显缓解,ODI评分明显改善(P<0.01)。术后1年随访时采用Macnab评定标准评估疗效,结果优17例,良29例,可4例。术后1年时受损神经根感觉、肌力明显恢复(P<0.01),但腱反射无明显恢复(P>0.05)。

结论:全内镜下腰椎间盘摘除、纤维环缝合术是安全、有效的微创脊柱外科手术技术,能减少全内镜下腰椎间盘摘除术后腰椎间盘突出的复发概率。
【关键词】腰椎  椎间盘移位  脊柱内镜手术  微创外科手术
 
Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture
ABSTRACT  

Objective: 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.

Methods: 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.

Results: All operations were successfully completed,of which 27 patients were treated with transforaminal approach(including 8 cases of L3,4 and 19 cases of L4,5),and 23 patients(including 11 cases of L4,5 and 12 cases of L5S1) 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 nerves were fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain,and the ODI score improved significantly(P<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 (P<0.01),but tendon reflexes were not significantly restored (P>0.05).

Conclusion: 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.
KEY WORDS  Lumbar vertebrae  Intervertebral disc displacement  Spinal endoscopic surgery  Minimal surgical procedures
 
引用本文,请按以下格式著录参考文献:
中文格式:李振宙,曹峥,赵宏亮,商卫林,侯树勋.全内镜下腰椎纤维环缝合术的技术要点及临床疗效分析[J].中国骨伤,2020,33(6):498~504
英文格式:LI Zhen-zhou,CAO Zheng,ZHAO Hong-liang,SHANG Wei-lin,HOU Shu-xun.Analysis of the technical key points and clinical effect of full-endoscopic lumbar annulus fibrosus suture[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(6):498~504
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