腰椎椎间孔镜微创手术中的区域定位原则及临床疗效观察

Regional positioning principle and clinical outcome observation of transforaminal endoscopic lumbar spine surgery

目的应用椎间孔镜技术治疗腰椎间盘突出症(Lumbar Disc Herniation,LDH),探讨区域定位原则的应用价值,评估临床疗效。方法收集应用椎间孔镜技术治疗LDH病例42例,对LDH进行临床分型,根据胡有谷区域定位原则,结合影像学特点,制定椎间盘突出致压部位靶点治疗手术方案。分别于术后6个月及末次随访进行疗效评估,记录视觉模拟疼痛评估VAS量表、腰椎疾患JOA量表、Oswestry功能残障指数及生活质量SF-36评估量表并评定分值,比较不同时点的治疗结果,计算临床治疗优良率及有效率。结果根据影像学特点结合胡有谷区域定位方法,将LDH分为中央型、旁侧型、椎间孔型、椎间孔外型、脱出游离型及特殊型,予以个性化微创手术治疗,平均随访(8.7±4.5)个月,术后6个月随访优良率为83.33%,总有效率为95.23%,末次随访优良率为85.71%,总有效率为92.86%。随访显示VAS、JOA、ODI及SF-36分值均能维持在较满意水平,与术前相比有显著差异(P<0.05)。结论区域定位原则具有临床实用意义,根据LDH类型及突出部位选择恰当的手术方式,是腰椎椎间孔镜手术成功的关键。

Objective Taking advantage of transforaminal endoscopic surgery technique to treat lumbar disc herniation （LDH）,we attempted to explore the clinical value of regional posi- tioning principle and assess the clinical outcome. Methods A total of 42 LDH cases undergone transforaminal endoscopic surgeries were included in the study. According to the imaging features and Hu＇s regional positioning principle,we conducted LDH clinical types and drew up surgical options of the protruded target treatment. All patients were followed-up regularly,and the clinical efficiency was evaluated at both 6 months after the surgery and the final time point. Scores of visual analogue scale （VAS）,JOA,Oswestry Disability Index （ODI） and SF-36 were calculated and recorded. These scores at different time points were analyzed and compared,and also,the clinical treatment efficiency was calculated. Results Based on imaging characteristics and Hu＇s endoscopic regional location,LDH was classified as central, lateral, foraminal,extra-foraminal, prolapsed and special types. Correspondingly,the individualized minimally invasive surgeries aimed at various types of LDH cases were successful. The mean follow-up period was （8.7±4.5） months. The total excellent rate was 83.33% and effective rate was 91.49% at 6 months postop-eratively,while the excellent rate was 85.71% and effective rate was 92.86% at the final follow-up. The follow-up data showed that the scores of VAS,JOA,ODI and SF-36 could maintain at a well- pleasing level,which presented significant difference compared with the scores preoperatively（P〈0.05）. Conclusion Target treatment concept has the clinical and practical significance. Selecting the ap- propriate surgical approach according to LDH types and protrusion sites plays a critical role in the application of transforaminal endoscopic surgery technique.