应用高频微创手术系统治疗腰椎间盘突出症

Application of HF Minimally Invasive Surgical System for the Treatment of Lumbar Disc Herniation

目的 探讨应用高频微创手术系统,采用髓核摘除、射频消融和纤维环成型的“三合一”技术治疗包容性腰椎间盘突出症的早期临床疗效.方法 2012年3月至2013年1月,我院对21例包容性腰椎间突出症患者应用高频微创手术系统,采用髓核摘除、射频消融和纤维环成型的“三合一”技术治疗,其中男14例,女7例;年龄32 ～55岁,平均37.5岁;单节段15例,双节段6例,其中L4-5（14节）,L5S1（13节）,对治疗前和术后2～3d、3个月、6个月及末次随访时的腰痛、下肢痛进行疼痛视觉模拟评分（visual analog scale,VAS）及末次随访Macnab评分对比分析.结果 手术时间30 ～ 55 min,平均46 min.术后随访6～17个月,平均12.5个月.术后无一例出现手术相关并发症.术后2～3d、3个月、6个月以及末次随访时腰痛VAS评分分别为：（1.10±0.65）分、（1.22±0.70）分、（1.15±0.75）分和（0.98±0.85）分,与术前腰痛VAS评分（5.30±1.52）分比较差异均有统计学意义;术后2～3 d、3个月、6个月及末次随访时下肢疼痛VAS评分分别为（1.25±0.69）分、（1.43±0.90）分、（1.32±0.84）分和（0.99±0.57）分,与术前（6.85±1.23）分比较差异均有统计学意义.按照Macnab评分标准,末次随访时优8例,良10例,可3例,优良率为85.7％ （8/21）.结论 应用双极射频微创手术系统“三合一”技术治疗包容性腰椎间盘突出症短期内临床疗效满意,但其远期效果仍待进一步观察.

Objective To evaluate the early clinical efficacy of ＂triple play＂ technique composed of removal of nucleus pulposus,radiofrequency ablation and annulus forming using the high-frequency minimally invasive surgical system for treatment of inclusive lumbar disc herniation.Methods Twenty-one patients with inclusive lumbar disc herniation were given ＂triple play＂ technique composed of removal of nucleus pulposus,radiofrequency ablation and annulus forming using high-frequency minimally invasive surgical system from March 2012 to January 2013,Among them,there were fourteen males and seven females aged from 32 to 55 years old,on the average of 37.5 years old.They were divided into fifteen cases of single segment and six cases of double segments,including lumbar 4 ～ 5 （24 segments） and L5 ～ S1 （13 segments）.The low back and leg pains at preoperatively,as well as three days,three months and six months postoperatively,and in the last follow-up period underwent visual analogue scale（VAS） and the last follow-up Macnab score for contrastive analysis.Results The operation time was from3 0 to 5 5 minutes,on an average of 4 6 minutes.Postoperative follow-up time was from 6 to 1 7 months,on an average of 12.5 months.No case of surgery-related complications happened postoperatively.The VAS scores for lower lack pains at three days,three months and six months postoperatively and in the last follow-up period were（1.10 ± 0.65） points,（1.22±0.70） points,（1.15 ± 0.75） points and （0.98 ± 0.85） points,respectively,with statistically significant differences compared with preoperative VAS score （5.30 ± 1.52）.The VAS scores for leg pains at three days,three months and six months postoperatively and in the last follow-up period were（1.25 ±0,69） points,（1.43 ±0.90） points,（1.32 ±0.84） points and （0.99 ±0.57） points,with statistically significant differences compared with preoperative VAS score （6.85 ± 1.23）.According to Macnab criteria,the last follow-up cases were excellent in 8 cases,good in 10 cases and fair in 3 cases,with an excellent rate of 85.7％ （18/21）.Conclusion The ＂triple play＂ technique using HF minimally invasive surgery system were applied for treatment of inclusive lumbar disc herniation with satisfactory clinical results in a short term,but its long-term effect still need to be observed.