区域穿刺可视化椎间孔成形术在经皮脊柱内镜治疗腰椎间盘突出症的临床应用

Clinical application value of regional puncture and visual foraminoplasty in the treatment of lumbar disc herniation with endoscopic surgery

目的探讨区域穿刺可视化椎间孔成形术在经皮脊柱内镜治疗腰椎间盘突出症的安全性及临床疗效。方法2019年1月-2019年12月采用经皮脊柱内镜治疗腰椎间盘突出症125例,依照手术方式分为区域穿刺可视化椎间孔成形组(可视化组)63例、TESSYS椎间孔成形组(TESSYS组)62例。比较两组患者手术时间、术中X线透视次数、手术相关并发症、术前及末次随访时患者下肢痛VAS评分,末次随访时采用Macnab疗效评定标准评价患者临床疗效。术后第2天、术后3个月复查CT及MRI,评价术后椎间孔成形情况及减压情况。结果所有手术均顺利完成,两组患者术后及末次随访时的下肢痛VAS评分较术前明显降低,差异有统计学意义(P<0.05);组间差异无统计学意义(P>0.05)。两组患者末次随访时的Macnab标准疗效比较,差异无统计学意义(P>0.05)。可视化组术中透视次数及手术时间明显低于TESSYS组,差异有统计学意义(P<0.05)。结论区域穿刺可视化椎间孔成形术治疗腰椎间盘突出症是一种安全、高效的手术方式,值得临床推广。

Objective To explore the safety and clinical efficacy of regional puncture and visual foraminoplasty in the treatment of lumbar disc herniation with endoscopic surgery.Methods A total of 125 patients with lumbar disc herniation who underwent percutaneous endoscopic surgery in our department from January 2019 to December 2019 were selected and divided into the regional puncture and visual foraminoplasty group(visual group,63 cases)and the standard TESSYS foraminoplasty group(TESSYS group,62 cases).The operation time,intraoperative X-ray fluoroscopy frequency,surgical complications,visual analog scale(VAS)scores of leg pain at the last follow-up were compared between the two groups,and the clinical curative effect was evaluated by using the MacNab efficacy evaluation criteria.CT scans and MRI of the lumbar spine in all patients were performed at 2 days and 3 months after surgery to evaluate the formation of intervertebral foramens and decompression.Results All operations were performed successfully.The VAS scores of leg pain after operation and at the last follow-up in two groups were significantly lower than preoperation,the differences were statistically significant(P<0.05).There was no significant difference between the two groups(P>0.05).There was no significant difference in the MacNab score at the last follow-up between the two groups(P>0.05).The times of X-ray fluoroscopy and operation time in the visualization group were lower than those in the TESSYS group,and there were significant differences between the two groups(P<0.05).Conclusion Regional puncture and visualization foraminoplasty in the treatment of lumbar disc herniation is safe and efficient,which is worthy of clinical promotion.