经皮椎间孔镜技术治疗复发性腰椎间盘突出症的临床疗效

Clinical Efficacy of Percutaneous Endoscopic Transforaminal Technique for Recurrent Lumbar Disc Herniation

目的探讨经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗复发性腰椎间盘突出的疗效。方法回顾性分析2019年3月~2022年6月23例复发性腰椎间盘突出症资料,首次腰椎间盘突出症手术切除突出间盘后6个月再次出现腰腿痛、麻木等症状,保守治疗3个月无效,腰椎MRI、CT、X线检查显示与首次腰椎间盘突出为同侧、同间隙。均在局部麻醉下行PTED。比较再手术前后腰腿痛视觉模拟评分(Visual Analogue Scale,VAS)和日本骨科协会(Japanese Orthopedic Association,JOA)评分,采用改良MacNab标准评估临床疗效。结果手术均顺利完成,手术时间45~115 min,(62.2±5.5)min;术中出血量5~20 ml;住院时间4~7 d,(5.1±0.5)d。术后残留腿痛麻木症状4例,腰背痛2例。随访6~38个月,(18.5±4.6)月。术后3天、术后3个月、末次随访腰腿痛VAS评分和JOA评分均较术前明显改善(P<0.05),改良MacNab标准优15例,良5例,可2例,差1例,优良率87.0%(20/23)。腰椎MRI显示手术节段无椎间盘突出复发。结论PTED可以有效治疗复发性腰椎间盘突出症,临床症状改善明显,术后功能恢复良好。

Objective To explore the clinical efficacy of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of recurrent lumbar disc herniation.Methods Clinical data of 23 patients with recurrent lumbar disc herniation who were admitted to our hospital from March 2019 to June 2022 were retrospectively reviewed.After the first surgery for lumbar disc herniation,symptoms such as lower back and leg pain and numbness reappeared at 6 months after the removal of the herniated disc.Conservative treatment was ineffective for 3 months.The MRI,CT,and X-ray examinations of the lumbar spine showed the same side and space as the first lumbar disc herniation.The PTED was performed under local anesthesia.The Visual Analogue Scale(VAS)and Japanese Orthopedic Association(JOA)scores for lower back and leg pain before and after reoperation were compared,and the clinical efficacy was evaluated by using the modified MacNab criteria.Results All the procedures were uneventful.The operative time was 45-115 min(mean,62.2±5.5 min),the intraoperative blood loss was 5-20 ml,and the hospital stay was 4-7 d(mean,5.1±0.5 d).After surgery,4 cases suffered from residual lower extremity pain and numbness symptoms,and 2 cases suffered from low back pain.Follow-ups ranged 6-38 months(mean,18.5±4.6 months).Postoperatively,the VAS scores of lumbar and leg pain and JOA scores were all improved at 3 days,3 months,and at last follow-up(P<0.05).According to the modified MacNab criteria,there were excellent outcomes in 15 cases,good in 5 cases,fair in 2 cases,and poor in 1,with the excellent and good rate being 87.0%(20/23).The MRI of the lumbar spine at last follow-up showed no recurrence of herniation at the operated segment.Conclusion PTED can effectively treat recurrent lumbar disc herniation with significant clinical improvement and good postoperative functional recovery.