经皮椎间孔镜下腰椎间盘切除术治疗下腰痛

Percutaneous endoscopic lumbar discectomy in the treatment of low back pain

目的探讨经皮椎间孔镜下腰椎间盘切除术(PELD)治疗下腰痛的可行性和有效性。方法回顾性总结2008年11月～2009年12月采用PELD治疗下腰痛患者79例,其中普通腰椎间盘突出症67例(合并轻度椎间孔狭窄44例),极外侧型腰椎间盘突出症6例,盘源性腰痛6例,所有椎间盘突出的均为包容型。于术前、术后1周及末次随访时进行视觉模拟疼痛评分(VAS),末次随访时按改良Macnab标准及患者满意度评价临床疗效。结果手术时间30～100 min,平均50 min;术后住院时间2～30 d,平均5.6 d。无手术并发症及转为其他手术方式。随访12～25个月,平均19.3个月。术前、术后1周及末次随访残余疼痛评分(VAS)分别是(8.75±0.25)、(4.12±0.51)、(3.86±0.43)分(P<0.05),1例患者末次随访时疼痛较术前加重。改良Macnab标准评价优良率70.9%,患者满意率63.3%。结论 PELD治疗下腰痛安全且近期效果良好,恰当的病例选择非常重要。

[ Objective ] To evaluate the feasibility and efficacy of treatment for low back pain with percutaneous endoscopic lumbar discectomy （PELD）. [ Method ] From November 2008-December 2009, 79 patients with low back pain were treated with PELD, which included 48 males and 31 females with average age of 49. lyears （range, from 16 to 81 years）. There were ordinary lumbar disc herniation in 67 cases （44 cases with mild for aminal stenosis）, 6 cases of far later al lumbar disc herniation, discogenic low back pain in 6 cases. Retrospective analysis of clinical results was performed. The clinical outcomes were determined using a modified Macnab criteria and patient satisfaction. [Result] The average operatige time was 50 minutes （ range, 30-100min）, with a mean postoperative hospital stay of 5.6 days （ range, 2-30 days）. There were neither complications related to the surgery, nor any conversion to open surgery. 79cases were followed up 12-25 months （average 19.3 months）. The Visual analog scale （VAS） scores of preoperation, 1 week after operation and last follow-up were （8.75＋0.25）, （4.12＋0.51）, and （3.86＋0.43） respectively （P 〈0.01）. One patient had an increased pain in the final follow up compared with preoperative. Excellent and good rate was70.9%, satisfaction rate was 63.3%. [ Conclusion ] PELD can achieve satisfactory short-term clinical results in treating low back pain and is a safe and efficacious minimally invasive surgical technique. Appropriate case selection is very important.