| 林龙泉,刘华,郑耿阳,等.膜椎韧带在椎间孔镜术中的形态学观察及其临床意义.骨科,2022,13(4): 338-343. |
| 膜椎韧带在椎间孔镜术中的形态学观察及其临床意义 |
| Morphology and Clinical Significance of Meningovertebral Ligament in Percutaneous Endoscopic Transforaminal Surgery |
| 投稿时间：2021-10-19 |
| DOI：10.3969/j.issn.1674-8573.2022.04.010 |
| 中文关键词: 非盘源性坐骨神经痛 膜椎韧带 经皮椎间孔镜技术 |
| 英文关键词: Non-discogenic sciatica Meningovertebral ligament Percutaneous transforaminal endoscopic surgery |
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| 中文摘要: |
| 目的 探讨膜椎韧带在椎间孔镜手术中的形态学观察及临床意义。方法 回顾性分析我院2018年1月至2019年10月20例因非盘源性坐骨神经痛，在侧卧位下行经皮椎间孔镜手术对椎间孔处膜椎韧带进行松解的病人的临床资料。记录病人术前、术后1 d、术后3个月日本骨科协会（Japanese Orthopaedic Association，JOA）、疼痛视觉模拟量表（visual analogue scale，VAS）评分，采用改良MacNab疗效评定标准评定手术疗效。结果 术中可见膜椎韧带在神经根鞘及硬脊膜腹侧、背侧均存在，膜椎韧带向后方一般附着于黄韧带或者椎板，其形态多样化，长度、宽度、类型无明显节段性或者阶梯性规律。20例病人术后均获得随访，随访时间为（6.60±1.70）个月。病人术后1 d、术后3个月的VAS评分[（3.20±1.06）分、（1.45±1.50）分]均明显低于术前[（7.50±1.15）分]，差异有统计学意义（P＜0.05）。术后3个月的JOA评分[（25.80±2.61）分]高于术前[（12.55±4.62）分]，差异有统计学意义（P＜0.05）。术后3个月随访根据改良MacNab疗效评定标准评定手术疗效，优14例，良4例，可1例，差1例，优良率为90%。结论 退变萎缩的膜椎韧带对硬脊膜及神经根存在一定的牵扯，采用侧路经皮椎间孔镜技术进行椎间孔处膜椎韧带松解，可以有效治疗非盘源性坐骨神经痛，为膜椎韧带的临床作用提供依据，为椎间孔镜治疗非盘源性坐骨神经痛提供一个新的手术思路。 |
| 英文摘要: |
| Objective To investigate the morphological observation and clinical significance of meningovertebral ligament in percutaneous transforaminal endoscopic surgery. Methods A prospective study was conducted on 20 patients with non-discogenic sciatica in our hospital from January 2018 to October 2019. These patients were prospectively selected to undergo percutaneous transforaminal endoscopic surgery to release the meningovertebral ligament at the foramen intervertebrale in the lateral position. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were recorded before, and 1 day, 3 months after operation. The modified MacNab efficacy evaluation standard was used to evaluate the surgical efficacy. Results During the operation, it was observed that the meningovertebral ligament lied on the ventral and dorsal side of the nerve root sheath and the dura. The meningovertebral ligament was posteriorly attached to the ligamentum flavum or the vertebral platey. Its morphology was diversified, and its length, width and type had no obvious segmental or stepped regularity. All the 20 patients were followed up satisfactorily for (6.60±1.70) months. The VAS scores at 1 day (3.2±1.06) and 3 months (1.45±1.50) after surgery were significantly less than those before surgery (7.50±1.15, P＜0.05). JOA score at the 3rd month after surgery was significantly higher than that before surgery (25.80±2.61 vs. 12.55±4.62), and the difference was statistically significant (P＜0.05). At the follow-up of 3rd month, according to modified MacNab criteria, 14 cases were excellent, 4 cases good, 1 case well, 1 case poor, and efficacy rate was 90%. Conclusion Degeneration of the meningovertebral ligament involves the dura mater and nerve roots. Percutaneous transforaminal endoscopic surgery to release the meningovertebral ligament at the foramen intervertebrale is effective for the non-discogenic sciatica. It provides the basis for the clinical function of the meningovertebral ligament and a new surgical idea for the treatment of spinal nerve root compression by percutaneous transforaminal endoscopic surgery. |
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