单侧后路经皮椎间孔镜技术治疗腰椎间盘突出症

Unilateral posterior percutaneous foraminoscopy technique in the treatment of lumbar disc herniation

目的探讨单侧后路经皮椎间孔镜技术治疗腰椎间盘突出症的疗效。方法采用单侧后路经皮椎间孔镜技术治疗47例腰椎间盘突出症患者(66个节段)。记录术中出血量、手术时间(从皮肤穿刺开始到缝合切口)、住院时间。采用疼痛VAS评分评价腰、腿部疼痛缓解情况;采用ODI及JOA评分评价腰椎功能恢复情况;采用改良MacNab标准评价临床疗效。结果患者均获得随访,时间6~18(10.2±3.7)个月。以单节段为计:术中出血量5~20(12.9±5.6)ml,手术时间50~112(85.6±14.7)min。住院时间5~24(9.0±4.1)d。疼痛VAS评分及ODI、JOA评分:术后各时间点均优于术前;术后随时间延长均越来越优(P<0.05)。末次随访时,采用改良MacNab标准评价的优良率为93.62%(44/47);影像学检查显示神经根受压完全松解,骨性狭窄压迫充分减压。结论单侧后路经皮椎间孔镜技术治疗腰椎间盘突出症,术中操作简单,方便多节段处理,且创伤小、并发症少、患者术后恢复较快,疗效可靠,较少影响腰椎稳定性,是一种安全、有效的方法。

Objective To investigate the clinical effect of unilateral posterior percutaneous foraminoscopy technique in the treatment of lumbar disc herniation.Methods A total of 47 patients with lumbar disc herniation(66 segments)were treated by unilateral posterior percutaneous foraminoscopy technique.The intraoperative bleeding volume,surgical time(from skin puncture to suturing incision),hospitalization time were recorded.The relief of waist and leg pain were evaluated by using the pain VAS;the lumbar functional recovery was assessed with ODI and JOA scores;and clinical efficacy was evaluated by using improved MacNab criteria.Results All patients were followed up for 6~18(10.2±3.7)months.Calculated as a single segment:intraoperative bleeding volume was 5~20(12.9±5.6)ml,and surgical time was 50~112(85.6±14.7)min.The hospitalization time was 5~24(9.0±4.1)d.Pain VAS,ODI,JOA score:Postoperative various time points were better than the preoperation;the performances generally got better and better with the time prolonging(P<0.05).At the last follow-up,the excellent-good rate evaluated with improved MacNab standard was 93.62%(44/47);imaging examination showed complete release of nerve root compression and sufficient decompression of bone stenosis compression.Conclusions For the treatment of lumbar disc herniation,unilateral posterior percutaneous foraminoscopy technique is a safe and effective method,with simple intraoperative operation,convenient multi-segment treatment,minimal trauma,fewer complications,faster postoperative recovery,reliable efficacy,and less influence on the stability of the lumbar spine.