内镜下可视化椎间孔成形治疗腰椎间盘突出症

Endoscopic Visualized Intervertebral Foraminoplasty for the Treatment of Lumbar Disc Herniation

目的分析内镜下可视化椎间孔成形治疗腰椎间盘突出症(LDH)的临床效果。方法回顾性分析2018年6月至2019年6月在郑州市骨科医院接受手术治疗65例LDH患者的病历资料,所有患者均接受内镜下可视化椎间孔成形治疗。记录手术时间、术中透视次数及并发症,并采用视觉模拟评分量表(VAS)、Oswestry功能障碍指数(ODI)评价手术效果,依据健康状况调查量表(SF-36)评价患者生活质量。末次随访时根据MacNab标准评估临床疗效。结果手术时间28~41 min,平均(37.7±11.6)min,术中透视次数为3~5次。3例患者术后第1天出现小腿后外侧麻木,无神经根撕裂、感染、血肿等严重并发症。所有患者均成功进行了随访,随访时间26~42个月,平均(31.6±8.1)个月。末次随访时,根据MacNab标准评估,其优良率为96.92%。术后1、3、6、12个月及末次随访下肢VAS评分及腰椎ODI评分均较术前降低(P<0.001)。末次随访时SF-36评分较术前提高(P<0.001)。结论内镜下可视化椎间孔成形治疗LDH具有临床效果明显、术后康复快等优势,是安全、有效、值得推广的微创治疗术式。

Objective To explore the clinical effect of endoscopic visualized intervertebral foraminoplasty for the treatment of lumbar disc herniation(LDH).Methods The medical records of 65 patients who underwent surgery for LDH from June 2018 to June 2019 in Zhengzhou Orthopaedic Hospital were retrospectively analyzed.All the patients were treated with endoscopic visualized intervertebral foraminoplasty.The operative time,times of fluoroscopy and complications were recorded.The surgical outcomes were assessed by visual analogue scale(VAS)and Oswestry disability index(ODI).The patient’s quality of life was evaluated according to the 36-items short form health survey(SF-36).The clinical efficacy was evaluated by the MacNab criterion at the last follow-up.Results The operation time was 28 to 41 minutes,with an average of(37.7±11.6)minutes,and the number of intraoperative fluoroscopy was 3 to 5 times.Three patients developed posterolateral leg numbness on the first day after surgery,and no nerve root tear,infection,hematoma or other complications occurred.All the patients were successfully followed up for 26 to 42 months,with an average of(31.6±8.1)months.The excellent and good rate was 96.92%according to the MacNab criterion at the last follow-up.One,three,six,twelve months and the last follow-up after surgery,the VAS scores of lower limbs and ODI scores of lumbar spine were all lower than those before surgery(P<0.001).The SF-36 score at the last follow-up was higher than that before surgery(P<0.001).Conclusion Endoscopic visualized intervertebral foraminoplasty for the treatment of LDH has the advantages of obvious clinical effect and fast postoperative recovery,which is a safe,effective and worth popularizing minimally invasive treatment.