经皮侧方入路椎间孔镜下髓核摘除治疗腰椎间盘突出症的疗效观察

Lateral percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation

目的探讨经皮侧方入路椎间孔镜下髓核摘除治疗腰椎间盘突出症的临床疗效。方法自2010年8月至2012年3月,经皮侧方入路椎间孔镜下髓核摘除治疗腰椎间盘突出症的患者256例。术前、术后1周及3个月随访采用日本骨科协会评分(JOA)评估腰椎功能改善情况。术前、术后1周及3个月随访时采用疼痛视觉模拟评分(VAS)评估疼痛程度。结果术后所有患者均获得随访,时间12～24个月(平均16个月)。256例患者的临床症状均得到明显改善,无一例出现脊柱不稳、神经粘连、神经根损伤、感染或硬脊膜撕裂等并发症。术后1周与术前在腰腿痛VAS评分的差异具有统计学意义(P<0.05);而术后1周与术后3个月比较时,差异则无统计学意义(P>0.05)。根据JOA评分标准,优225例,良18例,可13例,评分的优良率达94.9%。结论经皮侧方入路椎间孔镜下髓核摘除治疗腰椎间盘突出症,具有创伤小、出血少、安全性高、康复时间快、住院时间短等优点,与传统开放的手术相比疗效无明显差别。

Objective To evaluate the clinical efficacy of lateral percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation. Methods Between Aug. 2010 and Mar. 2012, sixty seven patients with lumbar disc hernia- tion were treated with lateral percutaneous transforaminal endoscopic discectomy. The total subjects received measurement with Japanese orthopaedics association （JOA） before operation, one weeks and three months after operation for estimation of lumbar function improvement as well as Visual analog score （VAS） for the pain relief. Results After operations, all the patients were followed up for 12-24 months （16 months averagely）. The clinical symptoms of all patients were improved more obviously, and there were no complications such as spinal instability, neuronal connectivity, nerve root injury, infection, dura tear. There were statistically significant differences in VAS between preoperation and one weeks after operation （P^0.05） ; and the differ- ence was not significant between 1 week postoperatively and 3months postoperatively （P^0.05）. According to the JOA stand- ard, the results were excellent in 225 cases, good in 18 cases, fair in 13 cases. Conclusion Lateral percutaneous transforamial endoscopic discectomy in the treatment of lumbar disc herniation provided minimal trauma, less bleeding, quick recovery, high security, short hospitalization time, and the differences between two operation methods were no significant