经皮腰椎间孔成形内窥镜下椎间盘切除术治疗腰椎间盘突出症的疗效观察

Clinical outcome of percutaneous lumbar foraminoplasty and transforaminal endoscopic discectomy in the treatment of lumbar disk herniation

目的:观察经皮腰椎间孔成形、经椎间孔内窥镜下椎间盘切除术治疗非包含型腰椎间盘突出症的近期疗效。方法:2007年4月～2007年7月收治非包含型腰椎间盘突出症患者26例,其中L3/44例,L4/512例,L5/S110例。应用自制椎间孔成形器械行经皮腰椎间孔扩大成形、经椎间孔内窥镜下椎间盘切除术,分析治疗前及治疗后9个月时腰痛及腿痛视觉模拟评分(VAS)的变化情况,术后9个月时采用MacNab功能评分判断疗效。结果:手术均顺利完成,手术时间45～120min,平均75min;术中出血量20～50ml,平均35ml。2例患者术后1周出现下肢"日光烧灼综合征",均为L5/S1椎间盘突出,经过脉冲电刺激治疗1周后缓解;无其他手术并发症发生。随访9个月,腰痛VAS评分术前6.3±2.5分,术后1d2.1±1.3分,术后3个月1.8±1.6分,术后9个月1.5±1.1分;腿痛VAS评分术前8.6±2.1分,术后1d1.1±0.7分,术后3个月0.5±0.6分,术后9个月0.3±0.1分;术后腰痛和腿痛的VAS评分较术前均明显降低(P<0.01)。按照MacNab评分标准,术后9个月随访时优18例,良8例,优良率为100%。结论:经皮腰椎间孔成形、经椎间孔内窥镜下椎间盘切除术治疗非包含型腰椎间盘突出症患者创伤小、近期疗效好。

Objective：To retrospectively analyze the short-term outcome of percutaneous foraminoplasty and transforaminal endoscopic disceetomy in the treatment of non-contained lumbar disk herniation.Method：26 patients with non-contained lumbar disk herniation （including 4 cases of L3/4,12 cases of IA/5 and l0 cases of L5/$1） confirmed by symptom,physical sign and concordant imaging were treated with percutaneous foraminoplasty and transforaminal endoscopic discectomy.The preoperative and postoperative visual analogue scores（VAS） were compared and the MacNab scores at 9th months follow-up were also evaluated.Result：All the procedures were performed successfully with operation time 45-120min （average 75rain） and blood loss 20-50ml （average 35ml）.Only 2 cases with L5/51 lumbar disk herniation were found complicated with sun- burn syndrome,which were relieved by pulsed electro-stimulant therapy for 1 week.After operation VAS of low back pain decreased from 6.3±2.5 of preoperative to 2.1±1.3 at lth day postoperative , 1.8 ±1 .6 at 3th months postoperative and 1.5＋-1.1 at 9th months postoperative.VAS of sciatica decreased from 8.6±2.1 of pre- operative to 1.1±0.7 at lth day postoperative,0.5±0.6 at 3th months postoperative and 0.3±0.1 at 9t monh postoperative.Postoperative VAS scores of low back pain and sciatica were significantly decreased compared with preoperative VAS scores （P〈0.01）.There were 18 excellent and 8 good according to MacNab score sys- tem,with total effective rate up to 100%.Conclusion：As an effective minimally invasive treatment alternative for non-contained lumbar disk herniation, percutaneous tbraminoplasty and transforaminal endoscopic discecto- my can ensure satisfying short-term clinical outcome.