经皮椎间孔镜技术治疗腰椎间盘突出症和腰椎间孔狭窄的并发症原因分析与处理

Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

目的分析经皮椎间孔镜技术治疗腰椎间盘突出症和腰椎间孔狭窄的并发症及其原因和相应处理措施。方法采用经皮椎间孔镜技术治疗286例经X线、CT或MRI证实的腰椎间盘突出症(201例)和腰椎间孔狭窄(85例)患者,视觉模拟评分(VAS)评价手术前后疼痛情况、Macnab标准评价手术疗效,记录手术相关并发症并分析原因及相应处理措施。结果与术前相比,术后3个月随访时VAS评分减少[1.00(0.00,1.50)分对8.50(7.75,9.25)分;Z=2.825,P=0.050];Macnab标准优良率达95.45%(273/286)。286患者中神经损伤8例(2.80%)、术区出血和神经根周围血肿形成6例(2.10%)、硬脊膜囊破裂1例(0.35%)、肌肉痉挛3例(1.05%)、感染1例(0.35%)、术后复发4例(1.40%),均予对症治疗后痊愈。结论经皮椎间孔镜技术治疗腰椎间盘突出症和腰椎间孔狭窄总体疗效满意,手术相关并发症发生率较低,通过术前评估,术中精细操作、仔细止血、缩短手术时间,以及术后对症处理,可以有效减少并发症的发生。

Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation （LDH） and lumbar intervertebral toraminal stenosis by percutaneous transforaminal endoscopic diseeetomy （PTED）. Methods From December 2009 to December 2014, 286 patients with I,I）H （N = 201） and lumbar intervertebral foraminal stenosis （N = 85） were confirmed by X-ray, CT or MRI and treated hy PTED in our hospital. Visual Analogue Scale （VAS） was used to evaluate the degree of pain in each patient before and after operation. The curative effeet was evaluated by Macnab score. Surgical complications were recorded to fimi nut the causes and methods to prevent them. Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 （0.00, 1.05） vs 8.50 （7.75, 9.25）; Z = 2.825, P = 0.050]. According to Maenab score, the rate of excellent and good funetional recovery was 95.45%（273/286）. Procedure-related complications included nerve injury in 8 cases （2.80%）, hemorrhage at the operation site and hematoma formation around nerve root in 6 eases （2.10%）, rupture of dural sac in one case （0.35%）, muscle cramps in 3 cases （1.05%）, surgical infection in one case （0.35%）, postoperative recurrence in 4 eases （1.40%）. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectumy for treating lumbar disc herniation and lumbar intervertehral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc.