经皮椎间孔镜下髓核摘除术治疗脱垂移位型腰椎间盘突出症的临床疗效

Clinical effect of percutaneous transforaminal endoscopic discectomy for treatment of migrated lumbar disc herniation

[目的]探讨经皮椎间孔镜下髓核摘除术（percutaneous transforaminal endoscopic discectomy,PTED）治疗脱垂移位型腰椎间盘突出症的手术技巧及临床疗效。[方法]2012年6月~2015年6月,共有32例脱垂移位型腰椎间盘突出症患者在本院接收经皮椎间孔镜下髓核摘除术治疗,按照Choi分型,其中高度脱垂移位14例,轻度脱垂移位18例。采用疼痛视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）及改良Macnab标准评价临床疗效。[结果]所有患者均获得随访,随访时间为（26.6±4.5）个月（3~39个月）。切口长度、手术时间、住院时间分别为（0.8±0.1）cm、（82.8±13.2）min、（5.0±1.5）d,术中透视次数为（33±6.5）次,患者术后腰腿疼痛明显缓解,术后各随访时间点腰腿痛VAS评分、ODI指数较术前均明显改善（P〈0.05）,1例出现术中颈部疼痛;1例高度脱垂移位的患者术中出现髓核残留,1例出现行走根损伤,经康复后症状好转。末次随访时按改良Macnab标准评定优良率分别为：高度脱垂移位型85.7%（12/14）,轻度脱垂移位型100%（18/18）,总体优良率93.8%（30/32）。[结论]PTED治疗脱垂移位型腰椎间盘突出症可取得较为满意的临床疗效,但对于高度脱垂移位的患者仍是一项挑战,髓核残留及神经并发症有一定的发生率。

[ Objective] To explore the surgical skills and clinical effect of percutaneous transforaminal endoscopic discectomy （PTED） in the treatment of migrated lumbar disc herniation （LDH） . [ Methods ] Thirty - two patients with migrated LDH underwent PTED in our hospital from June 2012 to June 2015. These patients were divided into 14 cases of high - grade mi- gration and 18 cases of low -grade migration according to Choi classification. The clinical outcomes were evaluated using the Vis- ual Analogue Scale （VAS）, Oswestry Disability Index （ODI）, and modified MacNab criteria. [ Results ] All patients were followed up for 3 - 39 months （ mean 26. 6± 4. 5 months） . The incision length, operation time, length of hospital stay, and times of intraoperative radiation exposure were （0. 8 ± 0. 1 ） cm, （82. 8± 13.2） min, （5.0 ± 1.5 ） days, and （ 33 ± 6. 5 ） times, respectively. After operation, lumbocrnral pain was significantly relieved in these patients, and the VAS score for lumbocrnral pain and ODI score were significantly improved at each follow - up point （P 〈 0.05 ） . There was one patient with neck pain during operation, one highly migrated LDH patient with residual nucleus pulposus during operation, and one patient with traversing nerve root injury, who showed an improvement in the symptom after rehabilitation. The last follow - up showed that satisfactory results were found in 12 （85.7%） of the 14 high - grade migration cases and all low - grade migration cases, with an overall satisfaction rate of 93.8% （30/32）, according to the modified MacNab criteria. [ Conclusion] PTED has a satisfactory clinical effect in the treatment of migrated LDH. However, it is still a challenge for patients with highly migrated LDH due to the presence of residual nucleus pulposus during operation and postoperative neurological complications.