经椎间孔经皮内镜治疗复发性腰椎间盘突出症

Efficacy of Percutaneous Transforaminal Microendoscopy Discectomy for Recurrent Lumbar Disc Herniation

目的探讨经椎间孔经皮内镜治疗复发性腰椎间盘突出症的早期疗效。方法 2011年10月～2014年6月我科对32例复发性腰椎间盘突出症采用经椎间孔经皮内镜腰椎间盘切除术,采用腰腿痛VAS评分、Oswestry功能障碍指数（Oswestry disability index,ODI）和改良Mac Nab疗效标准评定评价早期疗效。结果 32例术后随访12～26个月,术前腰痛VAS（7.2±2.1）分,术后3个月（2.9±1.8）分,差异有统计学意义（q=14.325,P〈0.05）,术后1年（2.3±1.0）分,与术后3个月比较差异无统计学意义（q=1.999,P〉0.05）;改善率（75.8±12.4）%。术前腿痛VAS评分中位数9.1分（4.1～9.9分）,术后3个月中位数2.4分（1.5～4.0分）,差异有统计学意义（Z=-4.937,P=0.000）,术后1年中位数2.1分（1.2～3.0分）,与术后3个月比较差异无统计学意义（Z=-1.609,P=0.108）;改善率（72.1±10.2）%。ODI术前55.4±10.2,术后3个月22.6±6.2,术后1年8.5±5.3,差异有统计学意义（F=325.90,P=0.000）;改善率（86.8±10.2）%。改良Mac Nab疗效评定标准：优14例,良12例,可4例,差2例,优良率81.2%（26/32）。结论经椎间孔经皮内镜治疗复发性腰椎间盘突出症疗效满意。

Objective To discuss the efficacy of percutaneous transforaminal microendoscopy discectomy in the treatment of recurrent lumbar disc herniation. Methods A total of 32 cases of recurrent lumbar disc herniation underwent percutaneous transforaminal microendoscopy discectomy by the same surgical team from October 2011 to June 2014. Early effects were observed by using the VAS scales of lower back pain and leg pain, the 0swestry disability index （0DI） , and the modified MaeNab criteria. Results All the cases were followed up for 12-26 months. The lower back pain VAS scores were （7.2＋2.1）, （2.9＋1.8）, and （2.3 _＋ 1. 0） points at preoperative, 3 month postoperative and 1 year postoperative time, respectively. There was statistical significance between preoperative and 3 month postoperative scores （q = 14. 325, P 〈 0.05） , while no statistical significance was seen between 3 month postoperative and 1 year postoperative （q = 1. 999, P 〉 0.05）. The average improvement rate was （75.8 ±12.4） %. The preoperative, 3 month postoperative and 1 year postoperative leg pain VAS scores （median） were 9. 1, 2.4, and 2. 1 points, respectively. There was statistical significance between preoperative and 3 month postoperative scores （Z = - 4. 937, P = 0. 000） , while no statistical significance between 3 month postoperative and 1 year postoperative scores was seen （Z = - 1. 609, P = 0. 108）. The average improvement rate was （72.1 ± 10.2）%. The preoperative, 3 month postoperative and 1 year postoperative ODIs were 55.4 ±10.2, 22. 6 ± 6. 2, and 8.5 ± 5.3, respectively, with statistically significant difference （ F = 325. 90, P = 0. 000）. The average improvement rate was （ 86.8 ± 10.2） % . The modified MacNab efficacy evaluation showed excellent in 14 patients, good in 12 patients, fair in 4 patients, and poor in 2 patients, the excellent and good rate being 81.2% （26/32）. Conclusion The posterior microendoseopy discectomy can achieve satisfactory clinical results in treating recurrent lumbar disc herniation.