椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症

~ITechnique skill and clinical choices of the YESS and TESSYS in percutaneous transforaminal endoscopic discectomy for lumbar disc herniations

目的探讨椎间孔镜YESS（Yeung endoscopic spine system） 和TESSYS（transforaminal endoscopic spine system）技术治疗腰椎间敏突出症的适应证、手术技巧及临床效果。方法2005年9月至2008年5月，201例腰椎间盘突出症患者分别采用YESS（150例）和TESSYS（51例）椎间孔镜手术治疗。男122例，女79例；年龄17-79岁，平均33．5岁。疗效评定依据疼痛视觉模拟评分（visualanaloguescore．VAS）和Nakai分级法。结果162例（80．6％）获得随访，YESS手术组119例（79．3％）、TESSYS手术组43例（84．3％）。随访3～36个月，平均12．5个月。YESS手术组术前腿痛VAS评分（8．4±2．1）分，术后1年（2.4±0．8）分，差异有统计学意义；TESSYS手术组术前腿痛VAS评分（8．6±2．3）分，术后1年（2．6±1-3）分，差异有统计学意义。YESS手术组优良率87．5％，TESSYS手术组88．4％。两组均尤永久性神经根损伤、大血管损伤和硬脊膜囊撕裂等并发症。YESS手术组6例术后无效，4例术后复发者行翻修术；TESSYS手术组1例术后无效，2例术后复发者行翻修术。结论椎间孔镜手术治疗腰椎间盘突出症安全、有效。根据小同类型和不同部位，正确选择YESS技术或TESSYS技术是手术成功的关键。

Objective To describe the techniques skill, indietions and clinical effects of the Yeung endoscopic spine system （YESS） and transforaminal endoscopic spine system （TESSYS） pereutaneous trans- foraminal endoscopic techniques for lumbar disc hemiations. Methods From September 2005 to May 2008, 201 patients with lumbar disc herniations were treated with posterolateral endoscopic discectomy techniques. There were two techniques had been used in this group： 150 cases with YESS and 51 with TESSYS. There were 122 males and 79 females, with an average age of 33.5 years. Results The fbllow-up period was 12.5 months （range 3 to 36 months）. 119 patients （follow-up rate was 79.3%） had been followed-up in YESS oper- ative group, while 43 patients （follow-up rate was 84.3%） in TESSYS operative group. Pain was measured by means of the Visual Analogue Score （VAS）, the patient satisfaction was evaluated by the Nakai outcome cri- teria. Mean VAS of YESS group was improved fl＇om 8.4＋2.1 before the surgery to 2.4＋0.8 one year after the surgery, while TESSYS group from 8.6＋2.3 betore the surgery to 2.6_＋1.3 one year after the surgery. There scores all increased significantly compared with their preoperative ones. Overall, excellent or good outcomes were obtained in 87.5% of the YESS group and in 88.4% of the TESSYS group. No persistent nerve root in- juries and dural tear were happened. Eight patients were unsatisfactory in YESS group and 3 in TESSYS group. Four patients （3.4%） were experienced persistent radiculopathy in YESS group, but only one （2.3%） happened radiculopathy in TESSYS group. Four recurrent cases （recurrent rate 3.4%） in YESS group and two recurrent patients （recurrent rate 4.7%） in TESSYS group had been underwent microendoscopie revision surgery＇. Conclusion Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of lumbar disc herniations. However, proper selection for YESS and TESSYS techniques is impor- tant to ensure the successful and satisfactory outcome for the lumbar disc herniations.