动力辅助下经皮全内窥镜结合全可视椎间孔成形术治疗腰椎间盘突出症疗效观察

Percutaneous transforaminal endoscopic discectomy combined with dynamically assisted visualized intervertebral foraminoplasty for lumbar disc herniation

目的如何提高椎间孔成形技术治疗的操作安全性已成为临床研究热点。文中旨在观察动力辅助下经皮全内窥镜结合全可视椎间孔成形术治疗腰椎间盘突出症的临床效果。方法收集2017年1月至11月江苏省中西医结合医院骨伤科61例腰椎间盘突出症患者。对患者进行动力辅助下经皮全内窥镜结合全可视椎间孔成形技术治疗。采用疼痛视觉模拟评分量表(VAS)、功能障碍指数(ODI)和改良Macnab疗效评定标准进行临床疗效评定。结果术后3 d、术后3个月、术后6个月VAS评分[(1.10±0.60)、(1.03±0.26)、(1.07±0.31)分]较术前[(7.64±1.11)分]明显降低(P<0.05); ODI评分[(2.10±0.54)、(1.30±0.49)、(1.23±0.46)分]较术前[(34.46±3.57)分]亦明显降低(P<0.05)。患者优良率96.72%(59/61)。所有患者术后无神经根损伤、脊髓损伤、硬脊膜破裂等并发症,无复发患者。结论动力辅助下经皮全内窥镜下结合全可视椎间孔成形技术治疗腰椎间盘突出症安全有效。

Objective How to improve the operational safety of foraminoplasty has become a hot spot in present clinical research.This study was to observe the clinical effect of minimally invasive treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy(PTED)combined with dynamically assisted visualized intervertebral foraminoplasty(VIVF). Methods Totally,61 patients with lumbar disc herniation underwent PTED combined with dynamically assisted VIVF in Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January to November 2017.We evaluated the clinical effects using the Visual Analogue Scale(VAS),Oswestry Disability Index(ODI)and modified Macnab Criteria. Results The VAS scores of the patients were significantly lower at 3 days,3 months and 6 months after surgery than the baseline(1.10±0.60,1.03±0.26 and 1.07±0.31 vs 7.64±1.11,P<0.05),and so were the ODIs(2.10±0.54,1.30±0.49 and 1.23±0.46 vs 34.46±3.57,P<0.05).The excellence rate of treatment 96.72%(59/61).None of the patients experienced such postoperative complications as nerve root injury,spinal injury,and dural matter,and no recurrence was observed. Conclusion PTED combined with dynamically assisted VIVF is safe and effective for the treatment of lumbar disc herniation.