经皮椎间孔内镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症

Percutaneous discectomy for targeted discectomy for lumbar disc herniation

目的探讨经皮椎间孔内镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症的临床疗效。方法选择94例腰椎间盘突出症患者,临床均给予经皮椎间孔内镜下靶向穿刺椎间盘切除术治疗。术后半年、1年采用疼痛视觉模拟评分(VAS)对患者的腰痛、腿痛进行评价,采用Oswestry功能障碍指数问卷表(ODI)对患者腰部功能进行评价,采用Macnab标准来评估患者临床总优良率,并且统计并发症(局部麻木感、脑脊液漏、硬脑膜微小撕裂、神经受损)的发生情况,并通过X线、MRI观察患者术后腰椎间盘情况。结果手术用时42~116min,平均74min;术中出血量25~55mL,平均40mL。术后切口均一期愈合;术后半年、末次随访,患者腰痛VAS、腿痛VAS、ODI评分均明显低于术前(P<0.05);术后半年总优良率为88.2%,术后1年总优良率为92.5%。术后半年椎体间隙较前变窄2例、成角>10°1例,术后1年椎体间隙变窄1例,所有患者在术后半年和末次随访均无椎间盘再次移位者。术后无局部麻木感、脑脊液漏、硬脑膜微小撕裂、神经受损等并发症出现。结论经皮椎间孔内镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症效果满意。

Objective To evaluate the clinical efficacy of percutaneous transforaminal endoscopic discectomy for lumbar disc herniation.Methods 94 patients with lumbar disc herniation were treated with percutaneous transluminal endoscopic targeted discectomy.The pain visual analogue scale(VAS)was used to evaluate the low back pain and leg pain in the first half of the year and one year.The Oswestry dysfunction index(ODI)was used to evaluate the lumbar function of the patient.The Macnab criteria were used to evaluate the overall clinical excellent rate.The incidence of complications(local numbness,cerebrospinal fluid leakage,dural tear,nerve damage)was observed,and the lumbar intervertebral disc was observed by X-ray and MRI.Results The operation time was 42-116 min,with an average of 74min.The intraoperative blood loss was 25-55 mL,with an average of 40 mL.All the incisions healed in the first stage.After half-year and last follow-up,the patients′low back pain VAS,leg pain VAS and ODI scores were significantly lower than those before operation(P<0.05).The total excellent and good rate was 88.2%after operation for half a year.The excellent and good rate was 92.5%after operation a year.In the second half of the year,the vertebral body space was narrower than the previous one,2 cases were angled>10°,and 1 case was narrowed in 1 year after operation.All patients had no intervertebral disc relocation in the first half of the operation and the last follow-up.There were no complications such as local numbness,cerebrospinal fluid leakage,micro-diabatic tear,and nerve damage.Conclusion Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation has less trauma,less bleeding,less complications,effective recovery of spinal stability,good intervertebral disc recovery,and satisfactory treatment results.