腰椎间盘突出症的经皮内窥镜激光椎间盘切除术

Percutaneous endoscopic laser-assisted discectomy for lumbar disc herniation： surgical technique, outcome, and complications in 6522 consecutive cases

目的 报告经皮内窥镜激光椎间盘切除手术（percutaneous endoscopic laser—assisted discectomy，PELD）治疗腰椎间盘突出症的效果和并发症。方法 患者包括腰椎间盘原发性突出、再突出、椎管内突出和椎管外突出者。回顾性研究PELD后至少1年的6522例患者，手术效果按照Oswestry功能障碍指数（Oswestry disability index，ODI）、疼痛视觉类比评分（Visual Analogue scale，VAS）和改良的Macnab标准评定。按Yeung等标准：中央型1329例（20．4％），旁正中型4186例（64．2％），椎间孔型433例（6．6％），椎间孔外侧型574例（8．8％）。结果患者平均年龄40．9岁，平均随访时间283个月，平均手术时间55min，平均出血量12ml。按照Macnab标准评定，优2805例（43．0％），良2902例（44．5％），可371例（5．7％），差444例（6．8％），其中成功率（优良率）为87．5％。患者问卷满意率为89．1％。术后并发症发生率4．6％，翻修率为6．8％。术后ODI、VAS与术前比较明显改善（P〈0．05）。结论 PELD治疗腰椎间盘突出症的手术效果与传统开放经椎管显微椎间盘切除术一致，椎管内和椎管外椎间盘突出及伴发侧隐窝狭窄的患者均可获得有效治疗。

Objective To describe a contemporary percutaneous endoscopic laser-assisted discectomy （PELD） technique for radiculopathy secondary to lumbar disc herniation; to evaluate the efficacy of PELD technique as it is applied to treat lumbar disc herniation; and to report outcome and complications. Methods A retrospective assessment of 6522 patients was performed at least 1 year after their index operation. These patients diagnosis included primary herniation, reherniation, intracanal herniation, and extracanal herniation in lumbar disc. The Oswestry disability index（ODI）, Visual Analogue scale（VAS）, modified Macnab criteria were employed to measure the outcome. A patient-based outcome questionnaire was also incorporated into the study. Results The average age of patients was 40.9 years old with the mean follow-up of 28.3 months. The mean operation time was 55 min, blood loss was 12 ml. According to the modified Macnab criteria, excellent outcome achieved in 2805（43.0%）, good 2902（44.5%）, fair 371（5.7%）, poor 444（6.8%）. The surgeon- performed assessment showed satisfactory results in 87.5% of the cases. The satisfaction rate toward the questionnaire was 89.1%. The combined major and minor complication rate was 4.6%, and the revision rate was 6.8%. Preoperative mean leg pain VAS decreased from （8.06±1.40） points to （3.10±1.69） points and the back pain VAS decreased from （6.75±2.34） points to （3.18±1.47） points. The ODI decreased from 65.39%±19.57% to 29.31%±13.28%. Conclusion The surgical outcome of PELD for lumbar disc herniation is comparable with that for the traditional open transcanal microdiscectomy. Intracanal and extracanal herniations, reherniations, and incidental lateral recess stenosis can be solved by the same procedure.