经椎间孔入路经皮内窥镜下椎间盘切除术治疗脱出型和游离型腰椎椎间盘突出症

Percutaneous endoscopic transforaminal discectomy for prolapsed and migrated lumbar disc herniation

目的评价经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)治疗脱出型和游离型腰椎椎间盘突出症(LDH)的临床效果。方法 2012年7月—2014年9月,对被诊断为脱出型和游离型LDH的48例患者采用PETD治疗。所有患者根据髓核脱出(NPP)的方向和远近分4型:Ⅰ型3例,Ⅱ型11例,Ⅲ型26例,Ⅳ型8例。采用疼痛视觉模拟量表(VAS)评分和改良Mac Nab标准评价临床疗效。结果所有病例手术均顺利完成,手术时间35~90 min,平均65 min;出血量5~20 mL,平均10 mL;住院时间2~30 d,平均3.5 d。2例患者术后出现患侧肢体麻木加重,1例术后出现脑脊液漏,1例术后出现椎间隙感染,经对症治疗后症状均消失。术后总体满意度为87.5%;各型分别为Ⅰ型67.7%,Ⅱ型90.9%,Ⅲ型92.3%,Ⅳ型75.0%。所有患者术后疼痛症状均有所缓解,末次随访VAS评分与术前相比,差异均有统计学意义(P<0.05)。所有患者术后15~45 d(平均30 d)均恢复正常工作。结论 PETD治疗脱出型和游离型LDH安全且有效,短期疗效满意。

Objective To evaluate the clinical efficacy of percutaneous endoscopic transforaminal discectomy（PETD） for treatment of prolapsed and migrated lumbar disc herniation（LDH）. Methods From July 2012 to September 2014,48 patients with prolapsed and migratedLDH were treated with PETD. All the patients were divided into 4 types according toLee＇s method based on nucleus pulposus prolapse（NPP） direction and distance ：type Ⅰ 3 cases,type Ⅱ 11,type Ⅲ 26,type Ⅳ 8. Visual analogue scale（VAS） score and modified Mac Nab criteria were used to evaluate the clinical effects. Results The operation was successful in all the cases. The operation time was 35- 90 min,mean 65 min. The blood loss was 5- 20 mL,mean 10 mL. The length of hospitalization was 2- 30 d,mean 3.5 d. Transient exacerbation of affected limb numbness was observed in 2 patients after surgery. One patient was found to have cerebrospinal fluid leakage,and one developed intervertebral space infection after operation. After symptomatic treatment,the symptoms disappeared. Postoperative overall satisfaction was 87.5%,and 67.7% for typeⅠ,90.9% for type Ⅱ,92.3% for type Ⅲ,and 75.0% for type Ⅳ. The pain symptom was relieved in all the patients at the final follow-up. Compared with the pre-operation,the difference was statistically significant（P〈0.05）. All the patients returned to normal work at a mean time of 30 d（15- 45 d）. Conclusion PETD is safe and effective for the treatment of prolapsed and migratedLDH. The short-term clinical outcome efficacy is satisfactory.