经皮内镜椎间孔入路微创治疗复发性腰椎间盘突出症疗效分析

Minimally Invasive Treatment of Recurrent Lumbar Disc Herniation with Percutaneous Endoscopic Intervertebral Foramen

目的探讨对复发性腰椎间盘突出症患者选择经皮内镜椎间孔入路微创方法治疗后获得的临床效果。方法方便选择该院2016年4月—2018年2月收治的70例复发性腰椎间盘突出症患者作为实验对象;临床均选择经皮内镜椎间孔入路微创方法展开病症治疗,就患者治疗后安全性以及症状改善情况加以观察,并且针对手术疗效,利用改良MacNab疗效评定标准以及VAS(疼痛视觉模拟评分)方法展开评定。结果所有复发性腰椎间盘突出症患者均顺利完成手术治疗,手术过程中未呈现出术式更改的患者。完成治疗后,均未表现出椎间隙感染、硬膜撕裂、神经根损伤以及椎旁血肿的现象。治疗后,1例患者表现出减压神经根支配区麻木症状,选择甲钴胺以及塞来昔布药物对患者进行口服治疗后,最终症状获得显著改善。治疗后12个月,对所有患者进行随访,针对手术疗效评定利用MacNab疗效评定标准完成,最终发现患者优41例(58.57%)、良23例(32.86%)、可5例(7.14%)、差1例(1.43%);此外,治疗后1个月、3个月以及12个月对患者进行随访,展开腿痛VAS评定以及腰痛VAS评定,最终发现,二者治疗后评分均明显低于治疗前(t=30.543、35.309、38.706、23.064、26.638、29.001,P<0.05);治疗后12个月VAS评分低于治疗后3个月差异有统计学意义(t=2.826、2.977,P<0.05);治疗后3个月VAS评分低于治疗后1个月,差异有统计学意义(t=6.340、4.733,P<0.05)。结论复发性腰椎间盘突出症患者在接受治疗期间,经皮内镜椎间孔入路微创方法的应用,于并发症减少,腿痛以及腰痛症状缓解方面,效果明显,最终对于复发性腰椎间盘突出症患者康复状态提升,奠定基础。

Objective To investigate the clinical effect of minimally invasive percutaneous transforaminal approach for patients with recurrent lumbar disc herniation.Methods Seventy patients with recurrent lumbar disc herniation admitted to the hospital from April 2016 to February 2018 were convenient selected as experimental subjects.The patients were treated with minimally invasive percutaneous transforaminal approach.The safety and symptom improvement after treatment were observed,and the evaluation was performed using the modified MacNab efficacy evaluation standard and the VAS(pain visual analog scale)method.Results All patients with recurrent lumbar disc herniation were successfully treated with surgery,and no patients with surgical changes were present during the procedure.After completion of treatment,no intervertebral space infection,dural tear,nerve root injury and paraspinal hematoma were observed.After treatment,one patient showed numbness in the decompressed nerve root innervation area,and the final symptoms were significantly improved after oral administration of mecobalamin and celecoxib.All patients were followed up for 12 months after treatment.The MacNab efficacy evaluation criteria were used to evaluate the surgical outcome.41 patients(58.57%)were excellent,23 cases(32.86%)were good,and 5 cases(7.14%)were available,1 patient(1.43%);in addition,patients were followed up at 1 month,3 months,and 12 months after treatment,and VAS assessment of leg pain and VAS assessment of low back pain were performed.It was significantly lower than before treatment(t=30.543,35.309,38.706,23.064,26.638,29.001,P<0.05);the VAS score at 12 months after treatment was significantly lower than 3 months after treatment(t=2.826,2.977,P<0.05).The VAS score at 3 months after treatment was significantly lower than 1 month after treatment(t=6.340,4.733,P<0.05).Conclusion The application of minimally invasive percutaneous transforaminal approach during recurrent lumbar disc herniation is effective in reducing complications,leg pain and relief of low back pain.The rehabilitation status of patients with disc herniation is improved and lays the foundation.