文献类型：期刊文献

中文题名：单孔非同轴脊柱内镜下经跨棘突入路治疗游离型腰椎间盘突出症的早期疗效

英文题名：Short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery via crossing midline approach in treatment of free lumbar disc herniation

作者：李中锋[1];刘晏东[2];温力鹏[2];陈博[2];杨英[3];王雨榕[1];彭冉东[1];宋恩[4]

第一作者：李中锋

机构：[1]甘肃省中医院脊柱疾病诊疗中心,兰州730050;[2]甘肃中医药大学研究生院,兰州730000;[3]临夏州人民医院骨科,甘肃临夏730030;[4]昆明医科大学第一附属医院运动医学科,昆明650032

第一机构：甘肃省中医院脊柱疾病诊疗中心,兰州730050

年份：2025

卷号：39

期号：1

起止页码：83

中文期刊名：中国修复重建外科杂志

外文期刊名：Chinese Journal of Reparative and Reconstructive Surgery

收录：;北大核心:【北大核心2023】；

基金：国家中医药管理局高水平重点学科建设项目(zyyzdxk-2023203);甘肃省自然科学基金(22JR5RA624);甘肃省临床优势专科建设项目(024);甘肃省重点人才项目(2024-4)。

语种：中文

中文关键词：单孔非同轴脊柱内镜;跨棘突入路;游离型腰椎间盘突出症;早期疗效

外文关键词：Uni-portal non-coaxial spinal endoscopic surgery;crossing midline approach;free lumbar disc herniation;short-term effectiveness

摘要：目的探讨采用单孔非同轴脊柱内镜(uni-portal non-coaxial spinal endoscopic surgery,UNSES)经跨棘突入路(crossing midline approach,CMA)治疗游离型腰椎间盘突出症(free lumbar disc herniation,FLDH)的早期疗效。方法2024年3月—6月,采用UNSES经CMA治疗16例FLDH患者。男9例,女7例;年龄47~62岁,平均55.1岁。病程8~30个月,平均15.6个月。病变节段:L3、44例,L4、55例,L5、S17例。术前疼痛视觉模拟评分(VAS)为(6.9±0.9)分,Oswestry功能障碍指数(ODI)为57.22%±4.16%。记录手术时间、术中出血量、术后住院时间以及相关并发症发生情况。术后采用VAS评分及ODI评价脊柱疼痛及功能情况,按照改良MacNab标准评价临床疗效;CT和MRI复查评价神经减压效果。结果16例患者手术均顺利完成,无手术相关并发症发生。手术时间63~81 min,平均71.0 min;术中出血量47.3~59.0 mL,平均55.0 mL;术后住院时间3~4 d,平均3.5 d。患者均获随访,随访时间1~3个月,其中随访达2个月15例、3个月14例。术后随时间延长VAS评分及ODI均逐渐降低,手术前后各时间点间比较差异均有统计学意义(P<0.05)。术后3个月,改良MacNab疗效评价达优12例、良2例,优良率达100%。随访期间影像学复查示椎管直径和横截面积明显增加,椎管有效减压。结论采用UNSES治疗FLDH时,选择CMA进行神经减压具有减压范围广、操作空间大以及操作自由等优势,可最大限度地保留关节突,避免峡部骨折断裂,清晰显示出口神经根和行走神经根,获得较好早期疗效。
Objective To investigate the short-term effectiveness of uni-portal non-coaxial spinal endoscopic surgery(UNSES)via crossing midline approach(CMA)in the treatment of free lumbar disc herniation(FLDH).Methods Between March 2024 and June 2024,16 patients with FLDH were admitted and treated with UNSES via CMA.There were 9 males and 7 females with an average age of 55.1 years(range,47-62 years).The disease duration was 8-30 months(mean,15.6 months).The pathological segments was L3,4 in 4 cases,L4,5 in 5 cases,and L5,S1 in 7 cases.The preoperative pain visual analogue scale(VAS)score was 6.9±0.9 and the Oswestry disability index(ODI)was 57.22%±4.16%.The operation time,intraoperative bleeding volume,postoperative hospital stay,and incidence of complications were recorded.The spinal pain and functional status were evaluated by VAS score and ODI,and effectiveness was evaluated according to the modified MacNab criteria.CT and MRI were used to evaluate the effect of nerve decompression.Results All 16 patients underwent operation successfully without any complications.The operation time was 63-81 minutes(mean,71.0 minutes).The intraoperative bleeding volume was 47.3-59.0 mL(mean,55.0 mL).The length of hospital stay after operation was 3-4 days(mean,3.5 days).All patients were followed up 1-3 months,with 15 cases followed up for 2 months and 14 cases for 3 months.The VAS score and ODI gradually decreased over time after operation,and there were significant differences between different time points(P<0.05).At 3 months after operation,the effectiveness was rated as excellent in 12 cases and good in 2 cases according to the modified MacNab criteria,with an excellent and good rate of 100%.CT and MRI during follow-up showed a significant increase in the diameter and crosssectional area of the spinal canal,indicating effective decompression of the canal.Conclusion When using UNSES to treat FLDH,choosing CMA for nerve decompression has the advantages of wide decompression range,large operating space,and freedom of operation.It can maximize the preservation of the articular process,avoid fracture and breakage of the isthmus,clearly display the exiting and traversing nerve root,and achieve good short-term effectiveness.