经皮椎间孔镜下椎板间入路治疗单节段腰椎间盘突出症的疗效分析

Clinical Effect Analysis of Percutaneous Endoscopic Interlaminar Discectomy in the Treatment of Single-segment Lumbar Disc Herniation

目的探讨全麻经皮椎间孔镜下椎板间入路(percutaneous endoscopic interlaminar discectomy,PEID)治疗单节段腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法 2012年3月~2016年1月我院采用PEID治疗86例单节段LDH。采用全麻下定位责任间隙,后正中旁开1~1. 5 cm进针,逐级扩孔至椎板间隙,插入椎间孔镜将突出的髓核组织取出。采用术后24 h和3、12、24个月疼痛视觉模拟评分(Visual Analogue Score,VAS)、日本骨科学会JOA评分及Oswestry功能障碍指数(Oswestry dability index,ODI)评估疗效。结果手术时间(42. 1±11. 8) min,术中透视(3. 1±1. 2)次,住院时间(5. 2±1. 5) d。86例随访(28. 4±3. 3)月。术前、术后24 h、3个月、12个月、24个月VAS、JOA评分和ODI较术前明显改善(P <0. 01);术后12个月与24个月VAS、JOA、ODI评分比较差异无统计学意义(P> 0. 05)。结论全麻PEID治疗单节段LDH疗效确切,值得推广。

Objective To evaluate the clinical effects of percutaneous endoscopic interlaminar discectomy (PEID) in the treatment of single-segment lumbar disc herniation (LDH) under general anesthesia. Methods A total of 86 cases of single-segment LDH were treated by PEID in our hospital from March 2012 to January 2016. Under general anesthesia, the responsible gap was located, and a posterior paracentric incision for 1-1.5 cm was opened for needle insertion. The tunnel was expanded step by step to the intervertebral disc space. The endoscope was inserted to remove the protruding nucleus pulposus tissue. The JOA, VAS scores, and Oswestry dability index(ODI) at 24 hours,3, 12 and 24 months after operation were observed to evaluate the clinical effects. Results The operation time was (42.1±11.8) min, the fluoroscopy number of times was (3.1±1.2) times, and the hospitalization time was (5.2±1.5) days. All the cases were followed up for (28.4±3.3) months (range, 24-38 months). The VAS, JOA scores and ODI at 24 hours, 3, 12, and 24 months after operation were significantly improved as compared to those of preopertion ( P < 0.01). There was no significant difference in VAS, JOA scores and ODI between 12 months and 24 months postoperatively ( P >0.05). Conclusion PEID under general anesthesia for the treatment of single-segment lumbar disc herniation is effective and clinically worthy of promotion.