全身麻醉下经皮椎间孔镜治疗腰椎间盘突出症的疗效分析

Analysis of the outcome of percutaneous endoscopic lumbar discectomy for lumbar disc herniation under general anesthesia

目的探讨采用全身麻醉下经皮椎间孔镜技术治疗腰椎间盘突出症的可行性及临床疗效。方法回顾性分析我院28例采用全身麻醉下经皮椎间孔镜技术治疗的腰椎间盘突出症患者的手术时间、术中出血量、手术费用及并发症等临床资料。比较手术前后腰腿痛视觉模拟量表(VAS评分)、Oswestry功能障碍指数(ODI)情况,按改良Macnab标准评价患者临床疗效。结果所有患者均顺利完成手术,手术时间平均(47.26±7.57)min;术中出血量平均(12.53±2.85)mL;手术总费用(3.24±1.12)万元,术中均无硬膜囊撕裂、神经根损伤、血管损伤、血肿形成、脏器损伤等并发症。28例患者随访12~49个月,平均(15.1±7.6)个月。患者术后1周、术后12个月腰痛VAS评分、腿痛VAS评分和ODI均低于术前,差异有统计学意义(P<0.05)。末次随访时临床疗效优良率为92.86%。术后复发1例,经腰椎后路开窗减压、髓核摘除术后治愈。结论全身麻醉下经皮椎间孔镜技术是治疗腰椎间盘突出症的有效方法,具有术中无痛苦、创伤小、恢复快等优点,适用于难以配合局部麻醉手术的患者。

Objective To investigate the feasibility and clinical efficacy of percutaneous endoscopic lumbar discectomy for lumbar disc herniation under general anesthesia.Methods The clinical data of 28 patients with lumbar disc herniation received percutaneous endoscopic lumbar discectomy under general anesthesia in our hospital were retrospectively analyzed,including the operation time,intraoperative blood loss,operation cost and complications.The visual analogue scale(VAS)score of lumbar and leg pain,and Oswestry disability index(ODI)before and after operation were compared.The clinical efficacy was evaluated according to the modified Macnab standard.Results The operations for all patients were completed successfully,with average operation time of(47.26±7.57)minutes,average intraoperative blood loss of(12.53±2.85)mL and total operation cost of(3.24±1.12)ten thousand yuan.There were no complications such as dural sac tear,nerve root injury,blood vessel injury,hematoma formation or organ injury occurred during the operation.The 28 patients were followed up from 12 months to 49 months,with an average of(15.1±7.6)months.VAS scores of lumbar and leg pain and ODI at 1 week and 12 months after operation were lower than those before the operation,and the differences were statistically significant(P<0.05).At the end of the follow-up,the excellent and good rate of outcome was 92.86%.Postoperative recurrence occurred in 1 case,which was cured after lumbar fenestration decompression and removal of nucleus pulposus.Conclusion Percutaneous endoscopic lumbar discectomy under general anesthesia is an effective method for the treatment of lumbar disc herniation,with the advantages of little intraoperative pain,less trauma,quick recovery and so on,which is suitable for patients who are difficult to cooperate with local anesthesia.