脊柱经皮侧后路椎间孔镜配以中药熨敷治疗腰椎间盘突出症的临床疗效分析

Diagnosis and Treatment of Lumbar Disc Herniation by Percutaneous Transforaminal Endoscopic Lumbar Discectomy and Traditional Chinese Medicine Ironing Treatment

目的：回顾性分析脊柱经皮侧后路椎间孔内镜配以中药熨敷治疗腰椎间盘突出症的方法及临床疗效。方法：2013年10月~2014年3月行腰椎X线正侧位片、过伸过屈动力位片、腰椎计算机断层扫描（CT）及核磁共振成像（MRI）辅助诊断18例腰椎间盘突出症患者,在局部麻醉下先行椎间盘造影术明确腰椎间盘突出主要责任节段,明确后行经皮侧后路椎间孔镜髓核摘除术。术后患者腰椎部位全部配合中药外用熨敷治疗。入院和术后随访时对患者腰腿痛进行视觉模拟评分（VAS）;采用Oswestry功能障碍指数（ODI）评估腰椎功能。结果：18例患者均成功实施手术,1例术中神经根损伤,无患者转开放手术。随访平均14.2个月。VAS由术前的平均7.17分下降到末次随访时的2.13分,差异具有统计学意义（P〈0.05）;ODI由术前平均53.15降至末次随访时的21.12。差异具有统计学意义（P〈0.05）。结论：经皮脊柱侧后路椎间孔内镜配以中药熨敷治疗腰椎间盘突出症中长期疗效满意,总体安全,并发症少,复发率低。

Objective：To conduct a retrospective analysis of diagnosis and treatment of lumbar disc herniation by percutaneous transforaminal endoscopic lumbar discectomy（ PELD） and traditional Chinese medicine（ TCM） i-roning treatment.Methods：From October 2013 to March 2014, 18 patients with lumbar disc herniation under-went PELD under local anesthesia.The patients were treated by TCM ironing treatment in post-operation.All patients underwent lumbar radiography, computed tomography（CT）and magnetic resonance imaging（MRI）. The primary responsible spinal level was treated by PELD.The preoperative and postoperative visual analogue scale（ VAS） was used to evaluate the sciatica and/or back pain.The outcomes were evaluated by Oswestry dis-ability index（ ODI） .Results：18 cases had the surgery performed successfully.One patient had nerve root in-jury complicated with paraestllesia and weakness of the affected lower extremity and was relieved gradually af-ter conservative treatment for over 3 months.No one had a conversion into open surgery.They were followed up for a mean period of 14.2 months.VAS was improved significantly from preoperative 7.17 to postoperative 2.13（P〈0.05）.ODI was decreased from preoperative 53.15 to 21.12 at the last follow-up（P〈0.05）. Conclusion：With fewer complications and a low recurrence rate,percutaneous transforaminal endoscopic lum-bar discectomy with TCM ironing treatment is safe and efficacious in the treatment of lumbar disc herniation.