基于椎间盘造影纤维环破口“靶点”导向椎间孔镜手术治疗椎间盘源性腰痛12例

Percutaneous transforaminal endoscopic treatment for discogenic low back pain guided by rupture site of anulus fibrosus

目的察以观椎间盘造影纤维环破口为“靶点”椎间孔镜手术治疗椎间盘源性腰痛的疗效。方法椎间经盘造影确诊的12例椎间盘源性腰痛患者,椎间盘造影后CT扫描定位纤维环破口,以纤维环破口为“靶点”椎间孔镜下经纤维环破口髓核摘除射频消融术。记录手术时间及出血量,观察手术并发症。术前、术后3 d以及1、3、6个月随访观察并记录患者腰痛觉模拟评分(VAS)。术后6个月按改良MacNab评分计算优良率。结果手术时间(53.3±16.5)min,出血量(12.2±6.3)mL。所有患者腰痛症状术后均得到明显缓解,术后各随访时间点的VAS评分与术前比较差异均有统计学意义(P<0.01),各随访时间点间比较差异无统计学意义(P>0.05)。术后6个月按改良MacNab评分优良率为91.7%。术后1例出现下肢感觉异常,经营养神经及对症处理1周后缓解。结论以椎间盘造影纤维环破口为“靶点”椎间孔镜下经纤维环破口髓核摘除射频消融术治疗椎间盘源性腰痛是一种微创、有效的手术方式。

Objective To observe the clinical effect of percutaneous transforaminal endoscopic treatment for discogenic low back pain guided by rupture site of anulus fibrosus.Methods 12 patients diagnosed with discogenic low back pain by discography were treated with percutaneous transforaminal endoscopic guided by rupture site of anulus fibrosus.The rupture site of anulus fibrosus was found by CT scan after discography.Percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty were performed under the guidance of rupture site of the anulus fibrosus.The operation time and amount of bleeding were recorded,and surgical complications were observed.Preoperative VAS score of low back pain and modified MacNab score before the surgery,3 d after the operation and follow-up at 1,3 and 6 months were recorded.The excellent rate of modified MacNab score was calculated at 6 months after the operation.Results The operation time was 53.3±16.5 min,and the amount of bleeding was 12.2±6.3 mL.All the patients had the low back pain significantly improved after the operation,and the VAS scores at each follow-up time point after the operation were statistically different from those before the treatment(P<0.01).There was no statistical difference among different follow-up time points(P>0.05).The excellent rate of modified MacNab score was 91.7% at 6 months after the operation.After the operation,one case had lower extremity paresthesia,which was relieved after the symptomatic treatment for one week.Conclusion Percutaneous transforaminal endoscopic treatment for discogenic low back pain guided by rupture site of anulus fibrosus is effective and minimally invasive.