经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄

Percutaneous Transforaminal Endoscopic Spine System in the Treatment of Lumbar Disc Herniation Complicated with Nerve Root Canal Stenosis

目的：探讨经椎间孔脊柱内窥镜（ transforaminal endoscopic spine system ，TESSYS）技术治疗腰椎间盘突出症合并神经根管狭窄的临床效果。方法回顾性分析2011年8月～2013年5月我院采用椎间孔镜TESSYS技术治疗40例腰椎间盘突出症合并神经根管狭窄的临床资料。使用德国joimax GmbH公司椎间孔镜，局部浸润麻醉，透视下穿刺至病变节段的椎间孔外侧，应用四级扩张导管逐级完成椎间孔扩大成形，环锯逐级扩大椎间孔，置入椎间孔镜，摘除突出髓核，直至神经根和硬膜囊完全松解。采用疼痛视觉模拟评分法（ VAS）及日本骨科学会（ JOA）下腰痛评分标准评价疗效。结果40例均完成手术，未发生神经根损伤、硬膜囊破裂、椎间隙感染等严重并发症。38例下肢疼痛症状术后即刻缓解，2例术后无明显缓解，于术后1周行椎间孔镜下翻修手术。40例随访6～30个月，平均11．8月，优19例（47．5％），良15例（37．5％），可6例（15.0％），差0例。优良率85．0％（34／40）。 VAS术后即刻（2．8±1．3）、术后3个月（1．7±0．8）及末次随访时（1．9±0．8）均低于术前（7．5±1．1）（t＝17．455，26．969，26．039，P均＝0．000）。 JOA评分术后3个月（23．1±2．5）及末次随访时（24．3±1.7）均高于术前（12．1±2．3）（t＝20．479，26．978，P均＝0．000）。结论 TESSYS技术治疗腰椎间盘突出症合并神经根管狭窄是一种安全、有效的微创手术方法。

Objective To explore the clinical effects of transforaminal endoscopic spine system （TESSYS） in the treatment of lumbar disc herniation with nerve root canal stenosis . Methods A retrospective analysis was performed on 40 cases of lumbar disc herniation and nerve root canal stenosis , all of whom were treated with TESSYS from August 2011 to May 2013.Transforaminal endoscopy （German, joimax GmbH） was used.After local infiltration anesthesia, the patients were punctured under the endoscopy to the diseased lateral intervertebral foramen .Dilating catheters were used gradually for forminal expansion and formation , while the trephine was used to gradually expand the foramen .Then a foraminal endoscopy was placed .The nucleus pulposus was removed under the endoscopy till the nerve root and dural sac were totally released .Visual analog pain score （ VAS ） and Japanese Orthopaedic Association （ JOA） low back pain score standard were used to evaluate the curative effects . Results All the 40 patients underwent operation successfully .No serious complications happened , such as nerve root injury , dural sac damage , or intervertebral space infection.Low limb pain was disappeared instantly after operation in 38 patients.Low limb pain did not change in 2 patients who underwent revision surgery under endoscopy 1 week after operation .All the 40 cases were followed up for 6 -30 months, with an average of 11.8 months.Nineteen cases （47.5%） were excellent, 15 cases （37.5%） were good, 6 cases （15.0%） were valid, and 0 case （0%） were invalid.The excellent and good rate was 85.0%（34/40）.The VAS was （2.8 ±1.3） instantly after operation, （1.7 ±0.8） after 3 months postoperatively, and （1.9 ±0.8） at the last follow-up visit, which were all lower than those before operation （7.5 ±1.1; t =17.455, 26.969, and 26.039, P =0.000）.The JOA scores were （23.1 ±2.5） after 3 months postoperatively and （24.3 ±1.7） at the last follow-up visit, which were all higher than those before operation （12.1 ±2.3;t=20.479 and 26.978, P =0.000）. Conclusion Percutaneous transforaminal endoscopic spine system is a kind of safe and effective treatment for lumbar disc herniation complicated with nerve root canal stenosis .