经皮椎间孔镜治疗腰椎间盘突出症开窗髓核摘除术后复发患者的疗效分析

Percutaneous endoscopic transforaminal discectomy for patients with recurrent lumbar disc herniation after fenestration discectomy

目的评价经皮椎间孔镜治疗腰椎间盘突出症开窗髓核摘除术后复发患者治疗的可行性。方法收集2013年5月至2019年1月在厦门大学附属福州第二医院脊柱外科收入住院的椎板开窗髓核摘除术后复发腰椎间盘突出症患者25例,其中男17例,女8例,年龄26~61岁。突出节段:L4~5节段18例,L5~S1节段7例。初次手术方式均为椎板开窗髓核摘除术。本组无症状间歇期为20个月~18年。全组均为下肢疼痛、麻木。所有患者均采用经皮椎间孔镜技术摘除突出的椎间盘组织,并松解必要的瘢痕组织,手术时间为85~120min。记录患者术前、术后第1日及术后3、6个月时疼痛视觉模拟评分(VAS),术后6个月采用改良MacNab标准评估临床疗效。结果全组患者均顺利完成手术,无其他因素转为传统开放手术者;术前VAS评分0~3的例数为0例,术后第1日时25例,与术前比较,术后第1日、3个月和6个月时腰腿痛的VAS评分均降低,差异有统计学意义(P均<0.05);术后6个月时改良MacNab标准评价疗效,其中优效18例,良效5例,差效2例,优良率92%(23/25例)。结论经皮椎间孔镜治疗腰椎间盘突出症开窗髓核摘除术后复发患者效果良好,可避开后方瘢痕组织,创伤小,是治疗腰椎间盘突出症术后复发的有效方法。

Objective To evaluate the feasibility of percutaneous endoscopic transforaminal lumbar discectomy (PELD) for the treatment of patients with recurrent lumbar disc herniation (RLDH) after fenestration discectomy. Methods Twenty-five patients with RLDH underwent PELD, including 18 males and 7 females, aged 26-61 years, from May 2013 to January 2019 were retrospectively summarized in the Department of Spine Surgery, Fuzhou Second Hospital Affliated to Xiamen University. The involved segments were L4-5 18 cases, and L5-S1 7 cases. All patients suffered from re-herniation were treated with fenestration discectomy for the first time. The mean pain-free interval was 20 months to 18 years. All patients showed lower extremity pain and numbness. The operation time was (85-120) min. PELD was used in a patient. The visual analogue scale (VAS) was applied to evaluate the effect at one day, three months and six months after the treatment. MacNab was used to assess the effect at six months after the treatment. The complications were also recorded. Results All patients successfully completed the operation, and no one was converted to traditional open surgery. The operation time was (93.7±8.6) min. Compared with pre-operation, VAS decreased significantly at one day, three months and six months after the operation in all patients (all P<0.05). Six months after the operation, the effects were excellent in 18 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 92%(23/25 cases) based on the MacNab evaluation. Conclusion The PELD is a good method for the treatment of patients with RLDH, by avoiding the scar tissue.