水平入路经皮椎间孔镜治疗近端脱垂游离型腰椎间盘突出症

Percutaneous transforaminal endoscopic discectomy for free migrated lumbar disc herniation with horizontal approach

目的探讨经皮椎间孔镜下水平入路治疗近端脱垂游离型腰椎间盘突出症的可行性。方法采用水平入路经皮椎间孔镜治疗16例近端脱垂游离型Lee分型Ⅰ区的腰椎间盘突出症患者。观察指标:手术时间,术前、术后即刻及末次随访时腰、腿疼痛VAS评分及ODI,术后即刻及末次随访时采用改良MacNab标准评价手术效果。结果患者均顺利完成手术,手术时间为30~180(96.2±9.5) min。术后下肢股前区麻木3例,经非手术治疗后症状完全缓解;股四头肌无力1例,1个月后症状消失;余12例无手术相关并发症。患者均获随访,随访时间12~24个月。术前、术后即刻、末次随访时,腰痛VAS评分分别为(5.02±1.41)、(2.73±0.81)、(1.94±0.68)分,腿痛VAS评分分别为(7.17±1.93)、(1.83±1.16)、(1.72±0.96)分,ODI分别为76.12%±11.35%、15.14%±5.37%、13.77%±5.32%;腰痛、腿痛VAS评分及ODI术后即刻与术前比较差异均有统计学意义(P <0.05),末次随访与术后即刻比较差异无统计学意义(P> 0.05)。末次随访时根据改良MacNab标准评价疗效:优13例,良3例。结论经皮椎间孔镜下水平入路治疗近端脱垂游离型腰椎间盘突出症安全、可行。

Objective To investigate the feasibility of percutaneous transforaminal endoscopic discectomy for migrated lumbar disc herniation with horizontal approach.Methods Sixteen patients diagnosed as migrated lumbar disc herniation of Ⅰregion according to Lee classification were treated with percutaneous transforaminal endoscopic discectomy with horizontal approach.Pain VAS and ODI were used to assess the low back pain and leg pain of preoperation,postoperation immediately and the last follow-up.Modified MacNab criteria was used to assess the status of recovery at postoperation immediately and the last follow-up.Results All the surgeries were carried out successfully,the operation were carried out 30 ~ 180( 96.2 ± 9.5) min.Three cases suffered from anterior proximal leg numbness but relieved completely with conservative treatment,another one suffered from incomplete paralysis of quadriceps femoris but recovered to normal a month later,and there were no direct surgical related complications of the rest.All the patients were followed up for 12 ~ 24 months.The VAS of low back pain of preoperation,postoperation immediately and the last follow-up were 5.02 ± 1.41,2.73 ± 0.81,1.94 ± 0.68,the VAS of leg pain of preoperation,postoperation immediately and the last follow-up were 7.17 ± 1.93,1.83 ± 1.16,1.72 ± 0.96 and the ODI of preoperation,postoperation immediately and the last follow-up were 76.12%± 11.35%,15.14%± 5.37%,13.77%± 5.32%,respectively.There were statistic differences comparing the VAS and ODI of postoperation immediately with preoperation( P < 0.05),but without difference in comparing postoperation immediately with the last follow-up( P > 0.05).At the last follow-up,according to Modified MacNab criteria: 13 cases were excellent,3 cases good.Conclusions Percutaneous transforaminal endoscopic discectomy for migrated free lumbar disc herniation with horizontal approach are safe and viable.