脊柱内窥镜下技术治疗腰椎间盘突出症的疗效分析

Analysis on Clinical Efficacy of Percutaneous Transforaminal Endoscopic Technique in the Treatment of Lumbar Spinal Disc Herniation

目的：评价经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症的临床疗效。方法：选择2011年7月-2013年3月本院收治并采用经皮椎间孔脊柱内窥镜下技术治疗的腰椎间盘突出症患者共265例，通过回顾分析治疗过程，并采用视觉模拟评分法（VAS）和Nakano改良标准评定治疗效果。结果：患者术前、术后7d、术后30d和术后180d的VAS评分分别为（7．27±1．34）分、（2．95±1．16）分、（1．52±1．04）分、（1．49±0．76）分，术后7、30、180d与术前VAS评分相比，差异有统计学意义（P〈0．05）。患者平均手术时间为（47．2±7．5）min，平均住院时间为7．8d。经治疗，优、良、可和差例数分别为209、45、11和0例，治疗优良率为95．85％。本组有2例患者术后过性下肢痛觉过敏，经对症治疗7～14d后得以恢复。患者整体恢复情况良好，未出现术后复发再手术、未发生神经根损伤，未出现术中大出血。结论：经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症可以有效避免创伤，具有出血少、恢复快、疗效好的优势，值得在临床治疗中推广使用。

Objective： To evaluate clinical efficacy of percutaneous t.ransforaminal endoscopic technique in the treatment of spinal lumbar disc herniation. Method： From July 2011 to March 2013, 265 cases of spinal lumbar disc herniation were treated with pereutaneous transforaminal endoscopic technique, therapeutic effect were evaluated by visual analogue scale France （ VAS ） and standard assessment Nakano. Result： The VAS scores were （ 7.27±1.34 ）, （ 2.95 ±1.16 ）, （ 1.52±1.04 ）, （ 1.49±0.76 ） before surgery and postoperative 7, 30, 180 d. Compared with before surgery, and VAS score in postoperative 7, 30, 180 d had significantly decreased （ P〈0.05 ） . The mean operative time was （ 47.2±7.5 ） min, the average length of stay was 7.8 d. After treatment, excellent, good, fair and poor patients were respectively 209, 45, 11 and 0 cases, the excellent and good rate was 95.85%.Two cases had lower extremity pain hyperalgesia and restored by symptomatic treatment after 7-14 d. Overall patient recovering well, did not appear recurrence after surgery, there was no nerve root injury, did not appear intraoperative bleeding. Conclusion： Percutaneous endoscopic transforarninal technique for lumbar spinal disc herniation can effectively avoid the trauma, with less bleeding, faster recovery, efficacy good advantage, it is worth to promote in the clinical treatment.