可视内镜联合椎间孔镜技术治疗脱出游离型椎间盘突出症的近期临床效果研究

Recent clinical ef fect of visual endoscopy combined with foraminal mirror technique in the treatment of prolapsed free disc herniation

目的 研究可视内镜联合椎间孔镜技术治疗脱出游离型腰椎间盘突出症的手术技巧及近期临床效果。方法 选取2018年8月至2020年7月采用俯卧位下可视经皮椎间孔镜下技术治疗脱出游离型腰椎间盘突出症患者56例作为研究对象。依据脱出不同类型采取偏心环锯技术和可视内镜下椎间孔成形技术。建立工作通道后,取出脱垂游离的髓核组织,解除相应解剖区域的神经压迫。术后采用视觉模拟评分法(VAS评分)、日本骨科学会(JOA)评分和改良Mac Nab标准评价临床效果。结果 所有手术均在椎间孔镜下顺利取出脱垂游离髓核。VAS评分随术后时间延长而显著减小,与术前比较差异有统计学意义(P<0.05);JOA评分随时间延长而显著增加,与术前比较差异有统计学意义(P<0.05)。根据改良Mac Nab标准,患者术后随访优占69.6%(39/56),良占23.2%(13/56),可占5.4%(3/56),差占1.8%(1/56),优良率为92.8%。术后患者下肢放射痛均得到明显缓解,即刻患肢直腿抬高试验结果为阴性。有1例患者硬膜轻度撕裂致术后出现双下肢麻木感,1 h后麻木消失,逐出现患下肢刺痛感,1周治疗后逐步消失。有3例患者出现下肢短暂性神经感觉异常或痛觉过敏,给予保守治疗2周后好转。有1例患者术后半年出现间盘复发,因年龄大选择保守治疗,仍存留患肢疼痛。结论 可视内镜联合椎间孔镜技术治疗脱出游离型腰椎间盘突出症的手术安全性和近期临床效果满意。

Objective To study the surgical techniques and recent clinical effect of visual endoscopy combined with foraminal mirror technique in the treatment of prolapsed free lumbar discherniation.Methods From August 2018 to July 2020,a total of 56 patients with prolapsed free lumbar disc herniation treated by visual percutaneous transforaminal technique in prone position were selected as the research subjects.According to the different types of prolapse,the eccentric trephine technique and the visual endoscopic foraminoplasty technique were adopted.After the working channel was established,the prolapsed and free nucleus pulposus tissue was removed to relieve the nerve compression in the corresponding anatomical area.Postoperative visual analogue scale(VAS),Japanese Orthopedic Association(JOA) score and modified MacNab criteria were used to evaluate the clinical effect.Results In all operations,the prolapsed free nucleus pulposus were successfully removed under the transforaminal microscope.The VAS score decreased significantly with the prolongation of postoperative time,and the difference was statistically significant compared with that before surgery(P<0.05);The JOA score increased significantly with time,and the difference was statistically significant compared with preoperative(P<0.05).According to the modified Mac Nab criteria,the postoperative follow-up of patients was excellent in 69.6%(39/56),good in 23.2%(13/56),fair in 5.4%(3/56),poor in 1.8%(1/56),and the excellent and good rate was 92.8%.The radiating pain in the lower extremity of the patients was significantly relieved after the operation,and the result of the straight leg raising test of the affected limb was negative immediately.One patient suffered from mild tear of the dura mater,which caused numbness in both lower extremities after operation.The numbness disappeared one hour later,and tingling in the lower extremities appeared one by one,which gradually disappeared after one week of treatment.There were three patients with transient neuroparesthesia or hyperalgesia in the lower extremities,which improved after two weeks of conservative treatment.One patient had disc recurrence half a year after operation,and conservative treatment was chosen due to his old age,but still had pain in the affected limb.Conclusion The surgical safety and recent clinical effect of visual endoscopy combined with foraminal mirror technique in the treatment of prolapsed free lumbar disc herniationare satisfactory.