经皮椎间孔镜技术在复发性腰椎间盘突出症治疗中的应用

Clinical application of percutaneous transforaminal endoscopic discectomy for recurrent lumbar disc herniation

目的探讨经皮椎间孔镜技术治疗复发性腰椎间盘突出症（recurrent lumbar disc herniation,RLDH）的方法与疗效。方法回顾性分析2010年7月至2015年7月于我院应用经皮椎间孔镜技术治疗并获得随访的56例腰椎间盘突出症复发患者的临床资料。比较本组患者手术前后的直腿抬高角度、疼痛视觉模拟量表（visual analogue scale,VAS）评分、日本骨科协会（Japanese Orthopaedic Association,JOA）评估治疗分数,并采用Macnab标准评估疗效。结果本组患者手术时间为40~150 min,平均75min;术中出血量为5~25 ml,平均10 ml;住院时间为4~14 d,平均7 d。术前患侧直腿抬高角度为（28.41±6.53）°,术后为（62.21±5.73）°;术前VAS评分为（8.04±1.12）分,术后为（2.42±1.38）分;术前JOA评分为（11.50±2.80）分,末次随访为（25.30±3.70）分。以上指标在手术前后数据的比较上,差异均具有统计学意义。所有患者均获随访,随访时间为3~60个月,平均28个月。根据Macnab标准进行评估：优28例,良19例,可6例,差3例,优良率为83.93%。结论对有合适手术适应证的RLDH患者,使用经皮椎间孔镜技术治疗具有不破坏腰椎稳定性、手术时间短、恢复快、术后并发症少等明显优势,治疗效果良好。

Objective To investigate the method and curative effect of percutaneous endoscopic lum-bar discectomy（PELD） for recurrent lumbar disc herniation（RLDH）. Methods The clinical data of 56 pa-tients with recurrent lumbar disc herniation treated by PELD from July 2010 to July 2015 in our hospital wereretrospectively. The patients were assessed by straight leg raising test angle（SLR）, visual analogue scale（VAS）score, Japanese Orthopaedic Association（JOA） score system and Macnab criteria. Results All patients weresuccessfully operated. The operation time was 40-150 min（mean 75 min）, the blood loss volume was 5-25 ml（mean 10 ml）, and the hospital stay was 4-14 days（mean 7 days）. The SLR before and after operation was（28.41±6.53）° and（62.21±5.73）° respectively. The VAS scores before and after operation were 8.04±1.12 and2.42±1.38 respectively. The JOA scores before and after operation were 11.50±2.80 and 25.30±3.70 respective-ly. There were significant differences perioperatively in the above indicators. All patients were followed up for 3-60 months（mean 28 months）. According to the Macnab criteria, the rate of clinical improvement was 83.93%（excellent in 28, good in 19, fair in 6 and poor in 3）. Conclusion Under the appropriate operation indications,there were obvious advantages of PELD for RLDH, such as no destruction for spine stability, shorter operativetime, quicker recovery, fewer complications, and better curative effectiveness.