椎间孔镜下髓核摘除射频热凝纤维环成形术治疗下腰痛的临床观察

Clinical outcomes of transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty in treatment of low back pain

目的观察椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛患者的诊治及术后疗效。方法 2012年6月至2013年6月,采用侧后路经椎间孔镜下髓核摘除、射频热凝纤维环成形术联合小关节突封闭治疗椎间盘源性腰痛患者。共60例,术前腰痛VAS评分为(6.71±1.13)分,ODI评分为(74.31±9.73)分。均采用椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗,术后1周、末次随访时进行腰痛VAS评分、ODI评分,末次随访时进行Mac Nab评分。结果末次随访VAS评分(1.37±0.87)分,改善率(80±9)%,ODI评分(16.98±5.86)分,改善率(77±10)%。术后各时间点评分较术前有明显降低(P<0.01)。按照Mac Nab评分标准,末次随访时17例优,41例良,2例可,总有效率100%,优良率97%。术后下腰痛复发3例(5%),出现椎间盘突出并行开放手术2例(3.33%)。神经根性痛觉过敏和灼样神经根痛4例(6.67%),给予营养神经、非甾体类药物等对症治疗,1周后症状缓解。结论椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛是一种安全、有效的治疗方法,在熟练掌握该技术后,手术并发症发生率低,手术疗效确切。

Objective To investigate the diagnostic value and postoperative outcomes of transforaminal endo-scopic discectomy and radiofrequency thermal annuloplasty in treatment of low back pain.Methods Transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty via the posterolateral approach,were used to treat patients with discogenic low back pain（n=60） between June 2012 and June 2013.The preoperative low back pain VAS score was 6.71 ± 1.13,and the ODI score was 74.31 ± 9.73.All patients underwent transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty in combination with facet joint blockage.The low back pain VAS score and ODI score were measured at 1 week after the operation and the last follow-up.The Mac Nab score was measured at the last follow-up.Results The last follow-up VAS score was 1.37 ± 0.87,with the improvement rate of（80±9）%,and the ODI score was 16.98 ± 5.86,with the improvement rate of（77 ±10）%.The scores at each postoperative time point was significantly lower than the preoperative scores（P〈0.01）.According to Mac Nab score system,the treatment efficacy was excellent in 17 cases,good in 41,and acceptable in 2 cases at the last follow-up.The total effective rate was 100%,and the excellence rate was 97%.Low back pain recurred in 3 patients（5%）,and 2 patients devel-oped protrusion of intervertebral disc necessitating open surgery（3.33%）.Four patients experienced nerve root hyper-algesia and sun-burn syndrome（6.67%） and were given nerve nutrition and non-steroidal drugs for the treatment,and the symptoms were relieved after 1 week.Conclusion Transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty is a safe and effective treatment for discogenic low back pain.In skillful hands,this technique is associated with low incidence of operative complications and evidenced surgical outcomes.