经皮椎间孔镜技术治疗腰椎间盘突出症的疗效分析

Analysis of the clinical effect of percutaneous transforaminal endoscopic technique for the treatment of lumbar intervertebral disc herniation

目的探讨经皮椎间孔镜技术（TESSYS）治疗腰椎间盘突出症的临床疗效。方法回顾性分析自2012-07—2014-03采用TESSYS技术治疗的腰椎间盘突出症128例。比较手术前后疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）,末次随访时采用改良Macnab标准评定手术疗效。结果本组手术时间65~160 min,平均95 min;其中建立通道时间35~70 min,平均50 min;镜下操作时间30~65 min,平均45 min。本组随访时间3~24个月,平均18.5个月。术后无复发患者。术后1例（L3神经根损伤）出现股四头肌无力,术后6周完全恢复。术后3个月（t=39.574,P〈0.001）、6个月（t=53.358,P〈0.001）VAS评分较术前明显降低,差异有统计学意义（P〈0.05）。术后3个月（t=40.998,P〈0.001）、6个月（t=54.578,P〈0.001）ODI指数较术前明显降低,差异有统计学意义（P〈0.05）。末次随访时采用改良Macnab标准评定临床效果：优109例,良11例,可8例,优良率93.8%。结论 TESSYS技术是治疗腰椎间盘突出症安全有效的新技术,具有微创、安全、适应证广、疗效可靠、恢复快的优点。

Objective To investigate the clinical efficacy of transforaminal endoscopic spine system（TESSYS） for the treatment of lumbar disc herniation. Methods A retrospective analysis of 128 cases of lumbar disc herniation treated by the TESSYS technique from 2012-07 to 2014-03 were performed. The pain visual analogue scale（VAS） and Oswestry functional disability index（ODI） were compared before and after surgery, and the curative effect was evaluated by using modified Macnab standard in the last follow-up. Results This operation time ranged from 65 to 160 mins, average of 95 mins; in which the establishment of channel time from 35 to 70 mins, average of 50 mins; mirror operation time from 30 to 65 mins, average of45 mins. The group was followed up for 3 to 24 months, average of 18.5 months. No recurrence was found in the patients.After operation, 1 case（L3nerve root injury） had quadriceps femoris weaknessour, and recovered completely after 6 weeks.After 3 months（t =39.574, P〈0.001）, 6 months（t =53.358, P〈0.001） VAS scores were significantly lower than before, and the difference was statistically significant（P〈0.05）. After 3 months（t =40.998, P〈0.001）, 6 months（t =54.578, P〈0.001）, the ODI index was significantly lower than before, and the difference was statistically significant（P〈0.05）. In the last follow-up, the clinical effects of modified Macnab criteria were evaluated： excellent in 109 cases, good in 11 cases, fairgood in 8 cases, the excellent and good rate was 93.8%. Conclusion TESSYS is safe and efficacious for treatment of lumbar disc herniation, and it is which has the advantages of minimally invasive, safety, adaptive, reliable with and quick recovery for the patients.