经皮椎间孔镜技术治疗腰椎间盘突出症

Percataneous endoscopic lumbar discectomy for the treatment of lumbar intervertebral disc protrusion

目的:探讨经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症的临床疗效。方法:对2014年5月至2016年4月采用经皮侧后方入路椎间孔镜TESSYS技术治疗的46例腰椎间盘突出症患者进行回顾性分析,其中男21例,女25例;年龄23~65岁,平均42岁;L_(2,3)2例,L_(3,4)3例,L_(4,5)28例,L_5S_113例;中央型5例,旁侧型34例,极外侧型7例。病程5~87个月,平均13.4个月。采用视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)及JOA评分评估患者疼痛缓解程度及腰椎功能改善情况,未次随访时采用改良Mac Nab标准评价临床疗效。结果:46例患者手术顺利,手术时间125~210 min,平均153.6 min。所有患者获得随访,时间6~12个月,平均8个月。无神经血管损伤及感染病例。VAS评分术后3 d及末次随访时分别为3.1±0.7和2.2±0.6,较术前的7.3±1.2明显改善(P<0.05)。末次随访时的JOA评分及ODI分别为(23.5±2.4)分和(22.10±9.26)%,均较术前的(13.2±2.8)分和(69.12±13.15)%,明显改善(P<0.05)。末次随访时按照改良Mac Nab标准评定结果 ,优30例,良14例,可2例。至末次随访没有发生间盘复发及翻修病例。结论:椎间孔TESSYS技术安全有效,近期疗效满意,适合腰椎间盘突出症的微创治疗。

Objective ： To explore the clinical effects of percataneous endoscopic lumbar discectomy for lumbar interverte- bral disc protrusion. Methods：The clinical data of 46 patients with lumbar intervertebral disc protrusion underwent percata- neous endoscopic lumbar discectomy were retrospectively analyzed. There were 21 males and 25 females, aged from 23 to 65 years old with an average of 42 years. The course of disease was from 5 to 87 months with an average of 13.4 months. Protrusion located in L2.3 of 2 cases, L3.4 of 3 cases, L4.s of 28 cases, L5S1 of 13 cases. There were 5 patients with central type, 34 with para- side type, 7 with extreme lateral type. VAS, ODI and JOA scores were used to analyze the condition of pain releasing and lum- bar functional improvement. According to MacNab standard to evaluate the clinical effect at final follow-up. Results ：All the operations were successful, operative time was 125 to 210 min with a mean of 153.6 min;and all the patients were follow-up for 6 to 12 months with an average of 8 months; no injuries of nerve and blood vessel,infection were found. Postoperative 3 days and final follow-up, VAS score was 3.1±0.7,2.2±0.6 respectively, and was obviously lower than preoperative 7.3±1.2 （P〈0.05）. At final follow-up, JOA and ODI were （23.5 ±2.4） points, and （22.10±9.26） %, respectively, and was obviously improved com- pared with preoperative （13.2±2.8） points and （69.12±13.15）% （P〈0.05）. According to modified MacNab standard to evalu- ate the clinical outcome, 30 cases got excellent results, 14 good, 2 fair, no recurred and overhauling were found. Conclusion： Percataneous endoscopic lumbar discectomy is a minimally invasive technique, with advantage of safety and effectiveness, and apply to treatment of lumbar intervertebral disc protrusion.