经皮椎间孔镜椎间盘切除术治疗腰椎间盘突出症近期疗效观察

Percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

目的:评价经皮椎间孔镜腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)治疗经保守治疗无效的腰椎间盘突出症的近期临床效果。方法:2008年11月至2009年7月,收治43例(70个退变间盘)经保守治疗无效的腰椎间盘突出症患者。其中男29例,女14例;年龄18～82岁,平均44.79岁;病程3～15个月,平均7.7个月。突出节段:L3.,44个,L4,536个,L5S130个。椎间盘退变分级:Ⅲ级42个,Ⅳ级28个。经椎间盘造影、透视证实椎间盘后方纤维环均撕裂,行PELD治疗。于术前、术后行疼痛视觉模拟评分(visual analogue scale,VAS),术前、术后末次随访时行Oswestry功能障碍指数(oswestry disability index,ODI)评定,按改良Macnab标准评价临床疗效。结果:手术时间1～2.5h,平均1.4h;术后住院时间5～8d,平均5.7d。43例均获随访,时间4～9个月,平均6个月。术中发生脑脊膜破裂1例(未发生脑脊液漏);术后当天出现一过性神经麻痹4例,未行特殊处理,末次随访时症状消失。术前VAS评分为(7.91±1.23)分,术后为(2.09±1.31)分;术前ODI指数为(74.22±16.61)%,末次随访为(17.88±8.20)%,术后VAS评分、末次随访ODI指数与术前比较均有统计学差异(P<0.01)。根据改良Macnab标准:优27例,良13例,可2例,差1例。结论:PELD安全有效,可用于治疗经保守治疗无效的腰椎间盘突出症患者。

Objective：To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy （PELD） in treating lumbar disc herniation after failed conservative treatment. Methods：From November 2008 to July 2009,43 patients with lumbar disc herniation after failed conservative treatment were treated with PELD,including 29 males and 14 females,aged from 18 to 82 years old（averaged 44.79 years）. Course of disease was from 3 to 15 months with an average of 7.7 months. MRI revealed 70 ＂degenerative discs＂ low in signal on T2 image,including 4 discs of L3,4,36 of L4,5 and 30 of L5S1. Degenerative grading had 42 discs of grade Ⅲ and 28 discs of grade Ⅳ. Discography showed positive response,fluoroscopy confirmed annulus fibrosus tears of posterior intervertebral disc in 70 discs. The clinical outcome were evaluated by visual analogue scale（VAS）,oswestry disability index（ODI） and modified Macnab criteria before and after operation or at the final follow up. Results：The mean operative time was 1.4 h （from 1.5 to 2.5 h）,and the mean length of stay was 5.7 d（from 5 to 8 d）. All patients were followed up from 4 to 9 months with an average of 6 months. Ruptured meninges occurred in 1 case （no found leakage of cerebrospinal fluid）. Transient paralysis of nerve occurred in 4 cases on the day of operation,and those symptoms disappeared at the final follow-up without special treatment. VAS scoring before and after operation was 7.91±1.23 and 2.09±1.31 respectively;ODI before operation and at the final follow-up was（74.22±16.61）% and（17.88±8.20）% respectively. There were significant differences compared with preoperative score （P0.01）. According to the modified Macnab criteria,27 cases were excellent result,13 good,2 fair,1 poor. Conclusion：Preliminary study showed that PELD is safe and effective in treating lumbar disc herniation after failed conservative treatment.