经皮椎间孔镜与显微镜治疗不同类型腰椎间盘突出近期疗效比较

The short-term clinical observation in patients of lumbar disc herniation with stenosis of intervertebral foramen between percutaneous transforaminal endoscopic discectomy and microscope operation

目的分析比较经皮椎间孔镜（transforaminal endoscopic spine system,TESSYS）技术与显微镜辅助下治疗不同类型腰椎间盘突出近期临床疗效及优缺点。方法 2010年6月至2013年12月,我科采用TESSYS下经皮侧后路腰椎间孔神经根松解和减压术（TESSYS组）和显微镜辅助下后路椎管及间盘内减压术（显微镜组）治疗189例腰椎间盘突出症患者,其中男103例,女86例,年龄26~82岁,平均52.1岁;中央型42例,旁正中型85例,外侧型14例,极外侧型5例,椎间孔型43例;TESSYS组120例,显微镜组69例。比较两组术前、术后3周、3个月、6个月的疼痛视觉模拟评分（visual analogue scale,VAS）,术后6个月随访时采用Mac Nab标准评价疗效。结果 TESSYS组平均手术操作时间（85±15）min,平均卧床时间（8±2）h,手术后平均住院时间（3.9±1.2）天;显微镜组平均手术操作时间（123±14）min,平均卧床时间（2.3±0.5）天,手术后平均住院时间（6.8±1.5）天。172例（91.0%）获得随访,TESSYS组109例（90.8%）,显微镜手术组63例（91.3%）。随访6~10个月,平均7.5个月。TESSYS组术前VAS评分（8.9±1.8）分,术后3周（1.8±0.5）分,术后3个月（1.0±0.3）分,术后6个月（0.8±0.2）分;显微镜组术前VAS评分（8.5±2.2）分,术后3周（1.4±0.3）分,术后3个月（1.1±0.4）分,术后6个月（0.6±0.2）分。两组在手术时间、卧床时间和术后住院时间上差异有统计学意义（P〈0.05）,两组VAS评分术前、术后3周、3个月、6个月与术前比较,差异有统计学意义（P〈0.05）,术后3周组间比较,差异有统计学意义（P〈0.05）。根据Mac Nab标准,术后6个月时随访TESSYS组优良率84.4%,显微镜手术组88.9%。两组均无永久性神经根损伤和硬脊膜囊撕裂等并发症。结论与显微镜手术相比,经TESSYS技术手术治疗腰椎间盘突出伴椎间孔狭窄症创伤小、手术时间短、术后恢复快、近期疗效可靠。在外侧及极外侧椎间盘突出伴椎间孔狭窄患者有其独特优势。

Objective To compare the short-term clinical effects of transforaminal endoscopic spine system （ TESSYS ） and microscope operation in the treatment of various lumbar disc herniation. Methods From June 2010 to December 2013, 189 cases （ 103 males, 86 females, aged 26 - 82 years, average 52.1 years ） of lumbar disc herniation were treated with endoscopic percutaneous transforaminal nerve root release and decompression （ TESSYS group ） and microscope assisted decompression （ Microscope group ）. Forty-two cases were of central type, 85 cases near to the central type, 14 cases lateral type, 5 cases extreme lateral type, 43 cases intervertebral foramen type. TESSYS group included 120 cases. Microscope group included 69 cases. Visual analog scale （ VAS ） was recorded before the surgery, 3 weeks postoperatively, 3 months postoperatively and 6 month postoperatively. MacNab was used for evaluation 6 months postoperatively. Results The average operation time of the TESSYS group was （ 85 ± 15 ） min, the average bed time was （ 8 ± 2 ） h, and the hospitalization time was （ 3.9 ± 1.2 ） d; while in the microscope group （ 123 ± 14 ） min, （ 2.3 ± 0.5 ） d and （ 6.8 ± 1.5 ） d. A total of 172 cases （ 91.0% ） were followed up： 109 cases were of group TESSYS （ 90.8% ）, 63 cases of microscope operation group （ 91.3% ）. All were followed up for 6 - 10 months （ average： 7.5 months ）. VAS scores of the TESSYS group were （ 8.9± 1.8 ） points before the operation, （ 1.8±0.5 ） points, （ 1.0 ± 0.3 ） points, （ 0.8 ± 0.2 ） points 3 weeks, 3 months and 6 months after the operation respectively, while in the microscope operation group （ 8.5 ± 2.2 ） points, （ 1.4 ±0.3 ） points, （ 1.1 ± 0.4 ） points, and （ 0.6± 0.2 ） points points respectively. Statistical significance existed in the operation time, bed time and postoperative hospitalization time between the 2 groups （ P 〈 0.05 ）. Statistical significance existed in VAS 3 weeks, 3 months and 6 months postoperatively compared with the data preoperatively （ P 〈 0.05 ）. Statistical significance existed 3 weeks postoperatively between the 2 groups （ P 〈 0.05 ）. The excellent and good rate was 84.4% and 88.9% in the TESSYS group and microscope group according to MacNab standard 6 months postoperatively. No permanent damage of nerve roots or dural sac tear were found in the 2 groups. Conclusions Compared with the microscope operation, TESSYS has advantages of less trauma, shorter operation time, quicker postoperative recovery, and reliable short-term effects in the treatment of lumbar disc herniation with stenosis, especially in lateral and extreme lateral lumbar disc herniation with stenosis.