经椎间孔镜下腰椎间盘髓核摘除术治疗腰椎间盘突出症

The lumbar disc herniation treated with percutaneous endoscopic lumbar discectomy

目的探讨经椎间孔镜下腰椎间盘髓核摘除术(PELD)治疗腰椎间盘突出症的疗效。方法采用PELD治疗50例腰椎间盘突出症患者。记录并发症发生情况,采用疼痛VAS评分、ODI评分评价患者疼痛以及腰椎功能改善情况,采用改良MacNab标准评价疗效。结果患者均获得12个月随访。术中发生硬膜囊撕裂1例,出血1例,类脊髓高压综合征2例。术后发生1例神经病理性疼痛。均未发生截瘫、感染等严重并发症。疼痛VAS评分、ODI评分术后各时间点均较术前降低(P<0.05);疼痛VAS评分术后1个月与术后1 d比较差异无统计学意义(P>0.05),术后3、6、12个月均较术后1 d降低(P<0.05);疼痛VAS评分及ODI评分术后3、6、12个月均较术后1个月降低(P<0.05),术后6、12个月均较术后3个月进一步降低(P<0.05),术后12个月与术后6个月比较差异均无统计学意义(P>0.05)。术后12个月采用改良MacNab标准评价疗效:优37例,良10例,可3例,优良率94%。结论PELD治疗腰椎间盘突出症可缓解患者疼痛,改善患者腰椎功能,疗效较好。

Objective To investigate the efficacy of percutaneous endoscopic lumbar discectomy(PELD)for the treatment of lumbar disc herniation.Methods Fifty patients with lumbar disc herniation were treated with PELD.The occurrence of complications were recorded,pain VAS and ODI score were used to evaulate the status of patient′s pain and lumbar function improvement,and the effect was evaluated by using the improved MacNab standard.Results All patients were followed up for 12 months.During the operation,there was 1 case of dural sac tear,1 case of bleeding,and 2 cases of myeloid hypertension syndrome.Postoperative neuropathtic pain occurred in 1 case.No serious complications such as paraplegia or infection occurred.The pain VAS and ODI score were both decreased at all time points after surgery,compared with before surgery(P<0.05).The pain VAS:there were no differences between postoperative 1 month and postoperative 1 d(P>0.05),while which was decreased at 3,6,12 months after surgery,compared with 1 d after surgery(P<0.05).The pain VAS and ODI score:they were both decreased at 3,6,and 12 months postoperation than postoperative 1 month(P<0.05),and further decreased at 6,12 months postoperatively,compared with 3 months postoperatively(P<0.05);there were no statistical differences between 12 months postoperatively and 6 months postoperatively(P>0.05).After 12 months of surgery,the modified MacNab standard was used to evaluate the efficacy:excellent in 37 cases,good in 10,fair 3,with an excellent-good rate of 94%.Conclusions PELD treatment of lumbar disc herniation can relieve pain,improve lumbar function,and have a good therapeutic effect.