Percutaneous Endoscopic Interlaminar Discectomy via Laminoplasty Technique for L(5) -S(1) Lumbar Disc Herniation with a Narrow Interlaminar Window.
Percutaneous Endoscopic Interlaminar Discectomy via Laminoplasty Technique for L(5) -S(1) Lumbar Disc Herniation with a Narrow Interlaminar Window.
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经皮内窥镜椎板成形术治疗窄层窗 L-5-S-1 腰椎间盘突出症
DOI：
10.1111/os.12978
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发表时间：
2021-05
影响因子：
2.1
通讯作者：
Cheng XG
中科院分区：
文献类型：
--
作者：
Wu TL;Yuan JH;Jia JY;He DW;Miao XX;Deng JJ;Cheng XG
为了提高L5S1椎板间窗狭窄的腰椎间盘突出症(LDH)患者的治疗效果，我们提出了一种经皮内窥镜下椎板成形术(PEID)的新方法。15例L5S1LDH患者，男7例，女8例，年龄22~56 ，中位年龄34 ，左 9例，右 6例。所有患者的椎板间窗均较窄(L5S1椎板间窗的横径等于或小于L4-5)。自2018年7月至2019年7月，所有患者均行经皮椎板成形术和内窥镜下椎板间髓核摘除术。所有手术均在局麻下完成。椎板成形术的靶区为安全区，安全区的使用避开了横根和出神经根。在透视引导或清晰的内窥镜下，使用环钻扩大椎板间窗口，使工作的套管进入椎管，但避开神经根和硬膜囊。对术前、术后视觉模拟评分(VAS)和OSwestry残疾指数(ODI)进行统计学分析。采用改良的MacNab标准评价临床疗效。通过MRI和CT对放射学结果进行评价。采用SPSS19.0软件进行统计评价。手术时间70~120min，中位数92min；透视次数8~12次，中位数9.7次。患者体重指数(BMI)范围为18.10~26.06，中位数为22.04。所有患者术后在门诊部进行至少12 月的随访。末次随访时，VAS-Back评分由5.33 ± 2.09降至2.00 ± 1.20(P <； 0.001)，VAS-Left评分由7.53 ± 1.69降至1.47 ± 0.92(P <； 0.001)。平均ODI值由治疗前的47.87 ± 11.41提高到12.93 ± 3.24(P <； 0.01)。根据改良MacNab标准，优11例，良4例。所有手术均获成功。无神经根损伤、硬脑膜撕裂等并发症。PEID椎板成形术为治疗椎板间窗狭窄的L5-S1腰椎管脱位患者提供了一种安全有效的方法。作者使用了一种创新的方法来更安全有效地对L5-S1椎板间窗狭窄的LDH患者实施经皮冠状动脉腔内成形术。
To improve the treatment effect of patients with L5S1 lumber disc herniation (LDH) with a narrow interlaminar window, we proposed an alternative approach to percutaneous endoscopic interlaminar discectomy (PEID) via the laminoplasty technique. Fifteen L5S1 LDH patients (7 men and 8 women; age range, 22 to 56 years; median age, 34 years; 9 left, 6 right) were enrolled in the present study retrospectively. The interlaminar windows of all patients were narrow (the transverse diameter of the L5S1 interlaminar window is equal to or less than that of L4–5). Percutaneous laminoplasty and endoscopic interlaminar discectomy surgery were undergone by all patients from July 2018 to July 2019. All operations were completed under local anesthesia. The target laminoplasty area was the safety zone, use of which avoids both transverse and exit nerve roots. Under fluoroscopic guidance or clear endoscopic visualization, the trephines were used to enlarge the interlaminar window, which allowed the working cannula to enter the spinal canal but avoid nerve roots and the dural sac. The preoperative/postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) were statistically analyzed. The modified MacNab criterion was used to assess the clinical effects. The radiological outcomes were evaluated by MRI and CT. SPSS 19.0 software was used for the statistical evaluation. The operative time ranged from 70 to 120 min, with a median time of 92 min, and the fluoroscopy times ranged from 8 to 12, with a median of 9.7 times. The body mass index (BMI) of patients ranged from 18.10 to 26.06, with a median of 22.04. All patients were followed up in the outpatient department for at least 12 months after surgery. At the last follow up, the average VAS‐Back score of the study patients was reduced from 5.33 ± 2.09 to 2.00 ± 1.20 (P < 0.001) and the average VAS‐Leg score was reduced from 7.53 ± 1.69 to 1.47 ± 0.92 (P < 0.001). The average ODI scores improved from 47.87 ± 11.41 to 12.93 ± 3.24 (P < 0.01). According to the modified MacNab criteria, 11 cases achieved excellent results and 4 cases achieved good results. All of the operations were successful. There wertr no nerve root injuries, dural tears, or other complications. The laminoplasty approach for PEID provides a safe and useful alternative for the treatment of L5–S1 LDH patients with a narrow interlaminar window. The authors used an innovative method to more safely and effectively perform PIED on LDH patients with L5–S1 with a narrow interlaminar window.
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影响因子：
1.9
作者：
Li, Zhen-zhou;Hou, Shu-xun;Zhao, Hong-liang
通讯作者：
Zhao, Hong-liang
DOI：
10.2106/00004623-198264050-00008
发表时间：
1982-01-01
影响因子：
5.3
作者：
SCHULTZ, A;ANDERSSON, G;NACHEMSON, A
通讯作者：
NACHEMSON, A
影响因子：
4.8
作者：
Choi, G;Lee, SH;Chae, YS
通讯作者：
Chae, YS
影响因子：
2
作者：
Sencer, Altay;Yorukoglu, Ali Guven;Canbolat, Ali Tuncay
通讯作者：
Canbolat, Ali Tuncay
影响因子：
2
作者：
Cheng, Liang;Cai, Heguo;Li, Qingchu
通讯作者：
Li, Qingchu