数字减影血管造影机引导下经皮椎间孔镜治疗腰椎间盘突出症的疗效观察

The clinical efficacy of DSA guided percutaneous transforaminal endoscopic discectomy treatment in patients with lumbar disc herniation

目的观察及评价经皮椎间孔镜治疗腰椎间盘突出症的临床疗效。方法回顾性分析该院自2015年3—11月收治的腰椎间盘突出症患者75例,所有患者均在数字减影血管造影机(DSA)引导下进行手术操作,根据具体情况分别采用YESS、TESSYS及BEIS技术行经皮椎间孔镜手术(PTED),通过观察患者视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)、改良Mac Nab标准以及直腿抬高试验角度等指标评价其疗效。结果所有患者手术均取得成功,技术成功率100%,均未发生术中神经根损伤、皮下血肿及椎间盘感染等严重并发症,其中1例患者因第一次PTED术后出现再突出,而再次行PTED手术,后取得满意疗效。VAS评分由术前的(7.2±1.3)分降至(2.1±0.4)分(t=32.255,P<0.001),ODI指数则由术前的(79.37±12.58)%降至末次随访的(15.83±3.13)%(t=42.164,P<0.001),直腿抬高试验则由术前的(34.71±8.52)°提升至(68.29±3.31)°(t=31.603,P<0.001),上述指标术前与术后比较均差异有统计学意义(P<0.05)。根据改良Mac Nab标准:优52例,良19例,可3例,差1例,优良率为94.7%,其中有3例患者术后出现下肢神经感觉功能改变,经对症治疗后均恢复正常。结论 PTED治疗腰椎间盘突出症安全有效,值得临床推广。

Objective To observe and evaluate the clinical efficacy of lumbar disc herniation by foraminal mirror technique.Methods There was a retrospective analysis of75lumbar disc herniation patients recruited by our department since March2015to November2015.All patients had received percutaneous transforaminal endoscopic discectomy by YESS,TESSYS and BEIS in accordance with specific conditions.The above operations were guided by DSA,to evaluate the efficacy according to the following observed index:VAS scores,Oswestry disability index,modified MacNab standard and the angle of straight-leg raising test.Results All patients′operation were accomplished with100%success rate,without serious complications such as nerve root injury,ecchymoma and intervertebral infection,one patient were treated with PTED for the first time,and the PTED operation was performed again.The preoperative mean VAS decreased from(7.2±1.3)points to(2.1±0.4)points(t=32.255,P<0.001)while ODI decreased from(79.37±12.58)%to(15.83±3.13)%(t=42.164,P<0.001),the straight leg raising test was raised to(68.29±3.31)°by the preoperative(34.71±8.52)°(t=31.603,P<0.001).The effects were excellent in52cases,good in19cases,fair in3cases and poor in1case according to modified MacNab criteria with the sum of excellent and good rate up to94.7%,3cases of patients with lower limb nerve sensory function changes,after symptomatic treatment were restored to normal.Conclusions There will be safe and effective which the lumbar disc herniation are treated by PTED combined with ozone,deserved to be expanded in the clinic.