腰椎间孔镜个性化手术入路治疗腰椎间盘突出症

Transforaminal endoscopic with individualized operative approach in treatment of lumbar intervertebral disc herniation

目的探讨经椎间孔个性化手术入路椎间孔镜技术治疗腰椎间盘突出症的临床疗效。方法依据每例腰椎间盘突出症患者的影像学图像,个性化制定最佳的靶向穿刺路径,运用我科自主研发的腰椎间盘突出靶点瞄准仪及靶向穿刺新方法,对50例腰椎间盘突出症患者实施椎间孔镜手术,对术后的疼痛视觉类比评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、Mac Nab评估进行回顾性分析。结果腰椎间孔镜个性化手术无神经、硬膜囊、大血管、肠道等组织损伤。平均随访11.6个月,术前术后VAS和ODI比较有统计学意义(P<0.05)。Mac Nab评定:优39例,良9例,可2例,差0例,优良率96.0%。结论椎间孔镜手术术前个性化制定穿刺入路可有效提升手术效果和降低并发症风险。

Objective To explore the clinical effect of percutaneous transforaminal endoscopic lumbar discectomy（ PTELD） in treatment of lumbar disc herniation via the transforaminal individual approach.Methods According to the x-ray,CT and MRI image of each patient with lumbar disc herniation,the best approach to target puncture developed individually. 50 patients with lumbar disc herniation were subjected to PTELD using a new targeted puncture technique with application of a lumbar disc herniation target guiding apparatus. The visual analogue scale（ VAS）,Oswestry disability index（ ODI）,Macnab postoperatively were reviewed. Results Nerve,dural sac,large blood vessels,intestinal tissue were not injured. Average follow-up for 11. 6 months,VAS and ODI scores preoperatively and postoperatively had statistically significant difference（ P〈0. 05）. According to Macnab criteria,the surgical outcomes were excellent in 39 cases,good in 9 cases,fair in 2 cases,with the excellent-to-good rate of 96. 0%. Conclusions Transforaminal endoscopic operation with preoperative individualized puncture approach can effectively improve the effect of surgery and reduce the risk of complications.