经皮椎间孔入路及椎板间入路椎间孔镜下髓核摘除术治疗腰椎间盘突出症50例的疗效分析

Clinical analysis of 50 cases of lumbar disc herniation treated with percutaneous lumbar endoscopic discectomy via transforaminal approach and translaminar approach

目的观察经皮椎间孔入路及椎板间入路椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床疗效.方法 50例腰椎间盘突出症患者,均行经皮椎间孔入路及椎板间入路椎间孔镜下髓核摘除术,分别于术前及术后1周、1个月、3个月评价所有患者的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI),并于术后3个月随访时按照改良Macnab标准评价患者的临床疗效.结果所有患者术后1周、1个月及3个月的VAS评分分别为(1.88±0.95)、(1.62±0.65)、(1.41±0.67)分,均明显低于术前的(7.53±1.01)分,术后1周、1个月及3个月的ODI分别为(29.62±5.84)%、(18.21±2.62)%、(15.41±1.73)%,均明显低于术前的(75.20±9.12)%,差异均有统计学意义(P<0.05).术后3个月随访时按照改良Macnab标准评价,优32例,良14例,可2例,差2例,优良率为92.0%.结论经皮椎间孔入路及椎板间入路椎间孔镜下髓核摘除术治疗腰椎间盘突出症的创伤小,并发症少,术后能早期下地行走,患者能够有效减轻疼痛,术后恢复较快,可作为治疗腰椎间盘突出症的首选方式.

Objective To observe the clinical efficacy of lumbar disc herniation treated with percutaneous lumbar endoscopic discectomy via transforaminal approach and translaminar approach. Methods A total of 50 patients with lumbar disc herniation all underwent percutaneous lumbar endoscopic discectomy via transforaminal approach and translaminar approach. The visual analogue score(VAS) and Oswestry dysfunction index(ODI) were evaluated before operation and 1 week, 1 month and 3 months after operation. The clinical efficacy was evaluated according to modified Macnab criteria at 3 months after operation. Results The VAS score in all patients at 1 week, 1 month and 3 months after operation were(1.88±0.95),(1.62±0.65) and(1.41± 0.67) points respectively, which were obviously lower than(7.53±1.01) points before operation. The ODI at 1 week, 1 month and 3 months after operation were respectively, which were obviously lower than(75.20±9.12)% before operation. Their difference was statistically significant(P<0.05). At 3 months follow-up, there were 32 excellent cases, 14 good cases, 2 fair cases and 2 poor cases, with excellent-good rate as 92.0% according to the modified Macnab criteria. Conclusion Percutaneous lumbar endoscopic discectomy via transforaminal approach and translaminar approach can be taken as the first choice for the treatment of lumbar disc herniation because of its minimal trauma, fewer complications, early walking after operation, effective pain relief and rapid recovery.