腰椎间盘突出症伴马尾神经损伤患者的经皮内窥镜治疗

An analysis of the clinical results of surgical treatment under percutaneous spine endoscope for cauda equina injury caused by protrusion of the lumbar disc

目的：评价经皮内窥镜治疗腰椎间盘突出症（ lumbar disc herniation，LDH ）伴马尾神经损伤的可行性和临床疗效。方法回顾性分析2011年1月至2013年8月，华西医院收治的 LDH 合并马尾神经损伤患者96例。采用经皮内窥治疗69例，于术前及术后末次随访时，进行疼痛视觉模拟评分（ visual analogue scale， VAS ），末次随访按 Nakano 等的标准评价临床疗效。结果术后随访66例，其中男38例，女28例，平均随访时间16（9～36）个月，腿痛 VAS 评分术前（7.68±1.12）分，术后末次随访（1.01±0.81）分，腰痛 VAS 评分术前（7.51±1.21）分，术后末次随访（1.63±1.42）分，腿痛与腰痛 VAS 评分术前与术后末次随访比较，差异均有统计学意义（P＜0.05）。术后末次随访按 Nakano 评分进行疗效评定：优23例，良21例，可18例，差4例。术后3个月随访 MRI 均见受压迫的神经减压良好、突出的髓核摘除彻底。结论经皮内窥镜对 LDH 伴马尾神经损伤治疗是一种可行的微创技术，能够彻底摘除突出的椎间盘组织，可以取得满意的临床效果。

Objective To evaluate the feasibility and clinical effects of surgery under percutaneous spine endoscope in single segmental cauda equina injury caused by the protrusion of the lumbar disc.Methods Ninety-six patients with cauda equina injury caused by the protrusion of the lumbar disc from January 2011 to August 2013 were retrospectively analyzed. Sixty-nine among them were operated under percutaneous spine endoscope. Visual analogue scale （ VAS ） was assessed preoperatively and during the lastest postoperative follow-up. Clinical efifcacy was evaluated by Nakano standard in the lastest follow-up.Results Sixty-six patients （ male 38, female 28 ） were followed up. The median follow-up time was 16 months （ range： 9-36 months ）. The preoperative VAS score of leg pain was 7.68±1.12. The mean VAS score of the lastest follow-up for leg pain was （ 1.01±0.81 ） points. The mean preoperative VAS score of back pain was 7.51±1.21. The mean VAS score of the lastest follow-up for back pain was 1.63±1.42. Differences were statistically signiifcant （P＆lt;0.05 ）. Clinical efifcacy was assessed by Nakano rating in the lastest follow-up： excellent 23, good 21, improved 18, poor 4. Three months postoperatively, MRI showed good decompression of the oppressed nerves and complete removal of the herniated nucleus pulposus.Conclusions Percutaneous spine endoscope technique is an ideal method for minimally invasive surgery in the treatment of single segmental cauda equina injury caused by the protrusion of the lumbar disc, which could completely remove the herniated nucleus pulposus and achieve satisfactory clinical effects.