椎间盘镜下神经根管减压术治疗根性症状为主的腰椎退行性病变

Nerve Root Canal Decompression under Intervertebral Disc Endoscope for Nerve Root Symptoms of Lumbar Degenerative Disease

目的探讨椎间盘镜下神经根管探查、减压术治疗有根性症状的腰椎退行性病变的临床疗效。方法 2010年1月～2011年12月对36例有根性症状的腰椎退行性病变在椎间盘镜下行神经根管探查、减压术,对比术前与术后6个月Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟评分(visual analogue score,VAS),评价临床效果。结果 36例在神经根管探查时均发现存在神经根管狭窄,对神经根有明显的压迫,神经根活动度<1 cm,进行神经根管减压后,神经根压迫解除,神经根活动度>1 cm。手术时间(61.7±5.6)min,出血量(60.0±9.7)ml,术后住院(3.5±0.5)d。36例随访6～29个月,平均17.5月:术前ODI评分(72.3±6.2)分,显著高于术后6个月(21.2±8.6)分(t=49.204,P=0.000);术后6个月VAS评分(3.3±0.1)分,显著低于术前(7.7±0.8)分(t=-141.496,P=0.000)。结论椎间盘镜下神经根管探查、减压术可彻底解除神经根压迫,显著缓解神经根性症状。

Objective To study the clinical effects of nerve root canal exploration and decompression with micro-endoscopic discectomy（MED） in the treatment of nerve root symptoms of lumbar degenerative disease.Methods Thirty six patients with nerve root symptoms of lumbar degenerative disease were carried out by nerve root canal exploration and decompression with micro-endoscopic discectomy from January 2010 to December 2011.Oswestry disability index（ODI） and visual analogue scale/score（VAS） were compared before operation and 6 months after operation.Results Nerve root canal exploration showed stenosis of the nerve root canal of all the 36 cases.Obvious compression was found and the nerve root range of motion was less than 1 cm.After being decompressed,the range of motion of the nerve root increased to more than 1 cm.The operation time was（61.7±5.6）min;blood loss was（60.0±9.7）ml;postoperative hospital stay was（3.5±0.5）d.The 36 cases were followed up for 6 to 29 months,with an average of 17.5 months.Compared with the ODI score 6 months after operation（21.2±8.6）points,the preoperative ODI score（72.3±6.2） points was significantly higher（t=49.204,P=0.000）.VAS score of 6 months after operation was（3.3±0.1） points,which was significantly lower than that before operation（7.7±0.8） points（t=-141.496,P=0.000） Conclusion Nerve root canal exploration and decompression with micro-endoscopic discectomy could totally relieve compression of nerve root,thus significantly reducing nerve root related symptoms.