一种新的经皮椎间孔镜技术治疗腰椎术后椎间盘突出症的疗效分析

A New Technique of Percutaneous Transforaminal Endoscopic Surgery for Lumbar Disc Herniation After Previous Intervention

目的探讨一种新的经皮椎间孔镜技术(percutaneous transforaminal endoscopic surgery,PTES)治疗腰椎术后复发、邻椎病等腰椎间盘突出症的可行性、安全性和有效性。方法回顾性分析2012年1月~2014年6月使用PTES治疗57例腰椎术后椎间盘突出症的资料,术后手术节段复发40例,术后手术节段残留7例,神经减压植骨融合术后邻椎病9例,L_5/S_1椎间孔镜术后发生L_(4/5)椎间盘突出症1例。均行PTES。随访2年,进行下肢放射痛视觉模拟评分(Visual Analogue Scale,VAS),采用Mac Nab法进行疗效评级。结果手术时间(52.4±5.9)min,中位术中透视次数5(4~14)次,出血量5(2~20)ml,住院时间3(2~4)d。术后即刻下肢放射痛VAS评分由术前的9(6~10)分降至1(0~3)分,术后2年随访为0(0~3)分。术后2年Mac Nab分级优51例,良5例,可1例,差0例。优良率98.2%(56/57)。无永久性神经损伤、腹腔脏器损伤、大血管破裂。结论 PTES技术治疗腰椎术后复发、邻椎病等椎间盘突出症简便、安全且有效。

Objective To evaluate the feasibility,safety,and efficacy of a new technique of percutaneous transforaminal endoscopic surgery（ PTES） for disc herniations after previous intervention. Methods A retrospective analysis was performed in 57 cases of disc herniations after previous intervention,including 40 cases of recurrent herniation,7 cases of residual fragments after previous intervention at the surgery level,9 cases of adjacent disc herniation after decompression and fusion,and 1 case of L_（4/5） herniation after transforaminal endoscopic discectomy for L_5/S_1. The PTES was carried out in all the cases. Preoperative and postoperative leg pain was evaluated by using the 10-point Visual Analogue Scale（ VAS） and the results were determined to be excellent,good,fair,or poor according to the Mac Nab classification during 2-year follow-ups. Results The duration of operation was（ 52. 4 ± 5. 9） min. The mean frequency of intraoperative fluoroscopy was 5（ 4-14） times. The blood loss was 5（ 2-20） ml.The length of hospital stay was 3（ 2-4） days. The VAS score of leg pain was dropped from 9（ 6-10） points before operation to 1（ 0-3） points immediately after the operation and to 0（ 0-3） points at 2 years after operation. During 2-year follow-ups,98. 2%（ 56/57） of the patients showed excellent（ 51 cases） or good（ 5 cases） outcomes,1. 8%（ 1/57） fair,and no poor outcomes. No patients had any form of permanent iatrogenic nerve damage or major complications. Conclusion PTES for recurrent,residual,and adjacent disc herniations after previous intervention is an easy,effective and safe technique.