经皮椎间孔镜技术行腰骶神经根减压松解术治疗腰椎间盘突出症

Decompression of lumbosacral nerve root in treatment of lumbar disc herniation by percutaneous transforaminal endoscopic spine system

目的探讨经皮椎间孔镜技术（TESSVS）行腰骶神经根减压松解术治疗腰椎间盘突出症的手术技巧和临床效果。方法回顾性分析自2013—12—2014—10采用TESSYS技术治疗的112例腰椎间盘突出症。术前、术后即刻、术后3个月及末次随访时采用疼痛视觉模拟评分（VAS）评价患者疼痛程度。末次随访时采用改良Macnab评分标准评价临床疗效。结果本组手术时间45—180win，平均58．6win；X线曝光频率13—62次，平均18．9次。术中硬膜囊撕裂7例，无神经根损伤、椎间隙感染等严重并发症。102例术后获得随访3—15个月，平均9．8个月。术前VAS评分（7．7±1．6）分，术后即刻（2．8±1．3）分，术后3个月（1．5±0．5）分，末次随访时（1．9±1．5）分。术后即刻VAS评分明显低于术前，差异有统计学意义（t=3．667，P=0．001）；术后3个月VAS评分明显低于术后即刻，差异有统计学意义（t=2．862，P=0．001）；末次随访与术后3个月VAS评分差异无统计学意义（t=0．033，P=0．120）。末次随访时采用改良Macnab评分评定疗效：优49例，良38例，可15例，优良率8513％。结论采用TESSYS技术行腰骶神经根减压松解术治疗腰椎间盘突出症是安全有效的微创手术，正确理解和掌握TESSYE技术点是保证手术成功的关键。

Objective To investigate the operative technique and clinical effect of decompression of lumbosacral nerve root in the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic spine system （TESSYS）. Methods One hundred and twelve patients between December 2013 and October 2014 were reviewed retrospectively. Visual analog pain score （VAS） and modified Macnab criterion were used to evaluate the curative effect. Results Mean operating time was 58.6 minutes（range 45-180 minutes）, and mean frequency of exposure to C arm machine was 18.9 times（range 13-62 times）. Dural tear occurred in 7 eases. No serious complications happened such as nerve root injury or intervertebral spaee infection. According to modified Macnab criterion, 102 cases were followed up for 3 to 15 months （mean 9.8 months）, 49 cases were excellent, 38 cases were good, 15 cases were fair, and the excellent and good rate was 85.3%. VAS scores instantly after operation （2.8±1.3）, 3 months after operation （1.5±0.5） and at the last follow-up （1.9±1.5） were all lower than those before operation （7.7±1.6）. The result of VAS scores instantly after operation were better than before operation（t =3.667, P =0.001）, and the result of VAS scores 3 months after operation was better than instantly after operation （t =2.862, P =0.001）. The result of the last follow-up was almost same as 3 months after operation （t=0.033, P =0.120）. Conclusion Decompression of lumbosaeral nerve root by TESSYS as a kind of minimally invasive technique is safe and effective for the treatment of lumbar disc herniation. Correct understanding of TESSYE technology is the key to ensure the successful operation.