单通道非同轴脊柱内镜经椎间孔外入路（椎板外切迹）治疗极外侧椎间盘突出症的临床疗效观察

Observation on the clinical efficacy of uni-portal non-coaxial spinal endoscopic surgery via extraforaminal approach (external lamina notch) in the treatment of far lateral lumbar disc herniation

摘要:

目的 观察单通道非同轴脊柱内镜经椎间孔外入路（椎板外切迹）治疗极外侧椎间盘突出症（FLLDH）的临床疗效。方法 回顾性分析2022年5月－2024年5月该院收治的，行单通道非同轴脊柱内镜经椎间孔外入路（椎板外切迹）治疗的FLLDH患者70例。于术前和术后，评估腰腿疼痛程度、腰椎功能和临床疗效。结果 相较于术前，术后3 d和3个月，患者下肢视觉模拟评分法（VAS）评分、腰部VAS评分、Oswestry功能障碍指数（ODI）、数字分级评分法（NRS）评分和Roland-Morris功能障碍问卷（RMDQ）评分明显降低，日本骨科协会（JOA）评分明显升高，差异均有统计学意义（P < 0.05）；改良MacNab评分标准显示，末次随访时的优良率为94.28%。结论 单通道非同轴脊柱内镜经椎间孔外入路（椎板外切迹）治疗FLLDH，能明显改善患者腰腿疼痛和腰椎下肢功能，其具有创伤小、易操作、安全性高和疗效好等优点，值得在临床推广应用。

Abstract:

Objective To evaluate the clinical efficacy of uni-portal non-coaxial spinal endoscopic surgery via extraforaminal approach (external lamina notch) for treating far lateral lumbar disc herniation (FLLDH).Methods A retrospective analysis was conducted on 70 patients with FLLDH who underwent uni-portal non-coaxial spinal endoscopic surgery via the extraforaminal approach (external lamina notch) from May 2022 to May 2024. Clinical outcomes were evaluated by assessing lower back and leg pain, lumbar spine function, and overall therapeutic efficacy before and after the operation.Results Compared with before the operation, at 3 days and 3 months after the operation, the visual analogue scale (VAS) scores for the lower limbs, the VAS scores for the waist, the Oswestry disability index (ODI), the numerical rating scale (NRS) scores, and the Roland-Morris dysfunction questionnaire (RMDQ) scores of the patients significantly decreased, while the Japanese Orthopaedic Association (JOA) score significantly increased. The differences were statistically significant (P < 0.05); according to the modified MacNab scoring criteria, the excellent and good rates at the last follow-up were 94.28%.Conclusion The uni-portal non-coaxial spinal endoscopic surgery through the extraforaminal approach (external lamina notch) for treating FLLDH can significantly alleviate patients' lower back and leg pain as well as their lower limb function. It has the advantages of small trauma, easy operation, high safety and good efficacy, and is worthy of clinical promotion and application.