全内镜可视化技术辅助动力磨钻经椎间孔入路治疗腰椎间盘突出症的近期临床疗效

The short-term clinical effect of percutaneous endoscopic lumbar discectomy assisted dynamic drill for the treatment of lumbar intervertebral disc herniation with the aid of full endoscopic visualization techniques

目的研究全内镜可视化技术辅助动力磨钻经椎间孔入路治疗腰椎间盘突出症的近期临床疗效。方法回顾性分析2019年6月至2020年12月首都医科大学附属北京友谊医院治疗的腰椎间盘突出症41例患者临床资料。其中突出节段L 3-43例,L 4-537例,L 5-S 11例。采用全内镜可视化技术辅助动力磨钻经椎间孔入路行腰椎间盘髓核摘除术。分别于术前及术后3个月、6个月、末次随访时采用腰、腿痛视觉模拟评分法(VAS)及Oswestry功能障碍指数(ODI)及MacNab标准评价手术效果。结果41例均顺利完成手术,术中无神经损伤等并发症,平均手术时间150.15 min,平均住院时间6.76 d。患者均获得随访,平均随访时间18.88个月。术后3个月、6个月、末次随访的腰痛VAS评分为(2.95±1.00)、(2.85±0.96)、(2.27±0.84)分,均低于术前[(5.68±1.01)分],差异均有统计学意义(P<0.05);术后3个月、6个月、末次随访的腿痛VAS评分为(2.56±0.98)、(2.39±0.92)、(2.22±0.73)分,均低于术前[(6.88±1.01)分],差异均有统计学意义(P<0.05);术后3个月、6个月、12个月的ODI为(28.06±7.52)%、(24.34±7.45)%、(18.24±7.56)%,均明显优于术前[(74.63±12.76)%],差异均有统计学意义(P<0.05)。术后12个月,手术效果优31例,良6例,可3例,差1例,优良率90.24%。结论全内镜可视化技术辅助动力磨钻经椎间孔入路治疗腰椎间盘突出症安全、有效、可行,近期临床疗效满意。

Objective To study the short-term clinical effect of Percutaneous endoscopic lumbar discectomy assisted dynamic drill for the treatment of lumbar intervertebral disc herniation with the aid of full endoscopic visualization techniques.Methods The clinical data of 41 patients with lumbar intervertebral disc herniation treated in Department of Spine Surgery,Beijing Friendship Hospital,Capital Medical University from June 2019 to December 2020 were retrospectively analyzed.Among them,there were 3 cases of protruding segment L 3-4,37 cases of L 4-5,and 1 case of L 5-S 1.The lumbar intervertebral disc nucleus pulposus was excised through the foraminal approach assisted dynamic drill with the aid of full endoscopic visualization techniques.The visual analogue scale(VAS),Oswestry dysfunction index(ODI)and MacNab criteria were used to evaluate the effect of surgery before and 3 months,6 months,and 12 months after surgery(or at the last follow-up).Results All 41 cases completed the operation successfully.There were no complications such as nerve injury during the operation.The average operation time was 150.15 min,and the average hospital stay was 6.76 d.All patients were followed up for an average of 18.88 months.The VAS scores of low back pain were(2.95±1.00)points,(2.85±0.96)points,and(2.27±0.84)points at 3 months,6 months,and last follow-up,which were all lower than those before operation[(5.68±1.01)points],the difference were statistically significant(P<0.05).The VAS scores of leg pain at 3 months,6 months,and the last follow-up were(2.56±0.98)points,(2.39±0.92)points,and(2.22±0.73)points,which were all lower than those before operation[(6.88±1.01)points],the differences were statistically significant(P<0.05).The ODI at the 3rd,6th,and the last follow-up were(28.06±7.52)%,(24.34±7.45)%,and(18.24±7.56)%,which were significantly better than those before operation[(74.63±12.76)%],the differences were statistically significant(P<0.05).Twelve months after surgery(or the last follow-up),MacNab was used to evaluate the curative effect:excellent in 31 cases,good in 6 cases,fair in 3 cases,and poor in 1 case,the excellent and good rate was 90.24%.Conclusion It is safe and feasible to use the full endoscopic visualization technology assisted the dynamic drill through the intervertebral foramina approach to treat lumbar disc herniation,and the short-term clinical effect is satisfactory.