经椎间孔内窥镜脊柱系统技术治疗脱垂型腰椎椎间盘突出症

Transforaminal endoscopic spine system in lumbar discectomy for procident disc herniation

目的探讨经椎间孔内窥镜脊柱系统(TESSYS)技术治疗脱垂型腰椎椎间盘突出症的疗效、围手术期并发症及处置对策。方法 2014年6月—2016年6月,泰州市人民医院骨科应用TESSYS技术治疗28例脱垂型腰椎椎间盘突出症患者,记录术前及术后各随访时间点的疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI),分析术中、术后并发症的发生情况,并探讨处置对策。结果所有患者随访3~24个月,平均11个月。患者术后VAS评分和ODI较术前明显降低,差异有统计学意义(P<0.05)。未发生神经损伤、椎管内血肿、感染等严重并发症。26例患者一次性顺利摘除脱垂髓核;2例患者术后即刻疗效不佳,1例经非手术治疗好转,1例再次行微创手术,末次随访疗效满意。结论 TESSYS技术是治疗脱垂型腰椎椎间盘突出症的有效方法,具有创伤小、恢复快等特点,但需注意预防并发症,谨慎的术中操作和严格的围手术期处理可预防或减少并发症的发生。

Objective To investigate the efficacy,perioperative complications and management strategy of transforaminal lumbar spinal system（TESSYS） in the treatment of prolapsed lumbar disc herniation. Methods From June 2014 to June 2016,a total of 28 subjects with prolapsed lumbar disc herniation were treated with TESSYS. The visual analogue scale （VAS） scores and Oswestry disability index（ODI） were recorded at pre-operation,immediate post-operation and follow-up period. Intraoperative and postoperative complications were analyzed,and the countermeasures were explored. Results The mean follow-up time was 11 months（3-24 months）. The postoperative VAS scores and ODI were significantly lower than those of the preoperation（P〈0.05）. No serious neurological damage,spinal hematoma,infection and other serious complications occurred. Two patients suffered adverse effects immediately after surgery. One was improved by nonoperative treatment,and the other one underwent minimally invasive surgery again,and the final follow-up was satisfactory. Conclusion Prolapsed lumbar disc herniation can be effectively treated with TESSYS,but the complications may happen.The complications can be prevented and diminished by careful intraoperative procedure and strict perioperative management.