杨氏椎间孔镜治疗腰椎间盘突出症的远期疗效

Long term effectiveness of Yeung endoscopy spine system(YESS^(TM)) in treatment of lumbar disc herniation

[目的]应用回顾性研究方法,探讨采用杨氏椎间孔镜(YESSTM)技术治疗腰椎间盘突出症的远期疗效。[方法]2000年6月～2003年5月期间采用YESSTM系统治疗112例腰椎间盘突出症患者,81例(72.3%)获得至少60个月随访(60～127个月,平均71.7个月)。男48例,女33例;年龄17～56岁,平均32.7岁。其中,椎孔型和椎间孔外型64例,后外侧突出型25例,中央型2例。33例合并神经根管狭窄的行椎间孔成形术。术前、术后2周和末次随访时分别对患者进行下肢疼痛的VAS评分,Nakai分级法评估治疗效果。[结果]所有患者手术均顺利完成,术中出血量30～120 ml,平均65 ml,手术时间35～140 min,平均70 min。无严重并发症,无椎间隙感染。5例(4.46%)术后无效,4例(3.35%)术后随访3～72个月复发,均再次行翻修术。14例(12.5%)术后出现一过性下肢疼痛加重,保守治疗后缓解。术前、术后2周和末次随访下肢疼痛的VAS评分分别为(7.4±2.1)、(2.4±0.8)、(2.2±0.6)。术后和末次随访评分较术前差异显著。Nakai分级法术后和末次随访的优良率分别为82.7%和77.7%,远期优良率无统计学差异。[结论]椎间孔镜YESSTM技术治疗腰椎间盘突出症能够获得良好的远期疗效。

[ Objective] To investigate the long term effectiveness of Yeung Endoscopy Spine System （YESSTM） in treat- ment of lumbar disc herniation by prospective study. [ Methods] From June 2000 to May 2003, 112 patients with lumbar disc herniations were treated with YESSTM technique and reviewed retrospectively. Total 81 cases （48 males and 33 females, aged from 17 to 56 years, average 32.7 years） were followed up for at least 60 months （60 - 117 months, average 71.7months） . Operated segments of L3,4, L4.5 and L5 S1 were in 20, 55 and 6 cases respectively. There were 64 cases of far - lateral lumbar disc herniations, 25 cases of posterolateral lumbar disc herniation and 2 cases of central lumbar disc herniations. Thirty - three cases with stenosis were operated with foraminotomy at the same time. Clinical outcomes were assessed by visual analog score （VAS） and Nakai criteria. [ Results ] All surgeries were carried out successfully without permanent nerve root injury, blood vessel injury , cerebrospinal fluid leakage , infection occurred in intervertenral space. Blood loss in this group was 65 ml （from 30 to 120 ml）, operative time was 70 rain （35 to 140 rain） . Five cases （4.46%） were unsatisfactory and were treated by open - window discetomy. Four cases （ 3.35% ） recurrent cases had underwent revision surgery after 3 - 72 months follow up. Forteen cases had transient leg pain after surgery and recovered in 1 week. The VAS score of pre - operation, 2 weeks post - operation and the last follow - up were 7. 4, 2.4 and 2. 2 respectively with obvious statistic difference. Two weeks post - opera- tion and the last follow - up of excellent or good outcomes rates were obtained in 82. 7% and 77.7% with no statistic difference. [ Conclusion] With careful selective indications, good long term effectiveness of Yeung Endoscopy Spine System （YESSTM ） can be got in treatment of lumbar disc herniation herniation.