经皮椎间孔镜治疗腰椎间盘突出症35例的近期疗效观察

Short-term efficacy of percutaneous transforaminal endoscopy in the treatment of 35 cases of the lumbar disc herniation

目的：观察经皮椎间孔镜技术（percutaneoustransforaminalendoscopicdiscectomy，PTED）治疗单节段腰椎间盘突出症患者的近期疗效。方法：选择单节段腰椎间盘突出症患者35例，行侧后路经皮椎间孔镜下髓核摘除术，应用疼痛视觉模拟评分（VAS评分）、改良Macnab标准评价其临床疗效。结果：35例手术均顺利完成，手术时间60～90min，术中出血量20～35ml。术后即刻腰腿痛明显减轻或消失。术中发生硬膜损伤、导针断裂各1例，术后发生神经根损伤、下肢感觉障碍1例，水肿反应1例。术后1周、术后1个月及3个月VAS评分均显著低于术前。根据改良Macanb标准评价疗效：优良率高。仅1例患者术后当天出现下肢轻度感觉障碍，经营养神经药物治疗，3个月后症状明显缓解。结论：经皮椎间孔镜技术是治疗腰椎间盘突出症的有效方法，近期疗效可靠。

Objective ： To observe the short-term efficacy of percutaneous transforaminal endoscopic discectomy （PTED） treat- ment in patients with single lumbar disc herniation. Methods ： Lateral-posterior approach percutaneous transforaminal endoscopic nucle- us pulposus discectomy was carried out in 35 cases of single lumbar disc herniation, the clinical efficacy was evaluated by the applica- tion of pain visual analog scale （ VAS score） and improved Macnab criteria. Results： The operation in 35 patients were successfully completed, the operation time was 60-90 rain, blood loss was 20-35 ml. The postoperative back and leg pain was significantly reduced or disappeared immediately. Intraoperative dural injury and guide pin fracture occurred in 1 case,respectively. Postoperative nerve root in- jury ,lower extremity sensory disturbances and edema reaction was found in 1 case, respectively. Compared with preoperative VAS score, it was significantly lower after 1 week, 1 month and 3 months postoperatively. According to improved Macnab evaluation criteria,the ex- cellence rate was much higher. Only 1 case reported mild lower extremity sensory disturbance on the same day of surgery, which was re- lieved 3 months after treatment of nerve nutrition drugs. Conclusions ： PTED is an effective treatment method for lumbar disc herniation and its short-term efficacy is reliable.