经皮椎间孔镜椎间盘切除术治疗复发性腰椎间盘突出症的疗效

Efficacy of Percutaneous Endoscopic Lumbar Discectomy in the Treatment of 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症的疗效。方法回顾性分析2014年1月～2016年4月48例复发性腰椎间盘突出症的临床资料,初次椎间盘切除术后6个月再次出现腰腿痛、麻木,经保守治疗3个月无效,经X线、CT及MRI检查明确为同节段腰椎间盘突出。均在局麻下行PTED。结果均顺利完成手术。手术时间45～100 min,(76. 5±16. 5) min;住院时间6～13 d,(8. 6±2. 3) d。住院费2. 6万～3. 4万元,(2. 9±0. 3)万元。48例随访12～46个月,平均26. 9月。术前疼痛视觉模拟评分(Visual Analogue Scale,VAS)(7. 0±1. 0)分,术后12个月降至(0. 9±0. 7)分(t=36. 469,P=0. 000);术前Oswestry功能障碍指数(Oswestry disability index,ODI)(29. 5±2. 3)%,术后12个月降至(9. 9±1. 4)%(t=71. 503,P=0. 000)。术后12个月按MacNab标准优38例,良6例,可3例,差1例,优良率91. 7%(44/48)。均未出现永久性神经根损伤、硬脊膜撕裂、感染及椎旁血肿等严重并发症。结论 PTED能有效治疗复发性腰椎间盘突出症,症状缓解及功能改善良好。

Objective To evaluate the efficacy of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of recurrent lumbar disc herniation.Methods A retrospective analysis was made on 48 cases of recurrent lumbar disc herniation from January 2014 to April 2016.The patients developed recurrence of lumbago,leg pain and numbness within 6 months after the first discectomy,which were ineffective after conservative treatment for 3 months.The same segment of lumbar disc herniation was confirmed by X-ray,CT and MRI.All PTED were conducted under local anesthesia.Results All the operations were completed successfully.The operation time was 45-100 min,with an average of(76.5±16.5)min.The hospitalization time was 6-13 d,with an average of(8.6±2.3)d.The hospitalization expenses ranged from 2.6×104 to 3.4×104 yuan,with an average of(2.9±0.3)×104 yuan.The 48 patients were followed up for 12-46 months,with an average of 26.9 months.The average Visual Analogue Scale(VAS)score was(7.0±1.0)points before the operation and(0.9±0.7)points at 12 months after operation(t=36.469,P=0.000);the average Oswestry disability index(ODI)was(29.5±2.3)%before the operation and(9.9±1.4)%at 12 months after operation(t=71.503,P=0.000).At 12 months after operation,the MacNab scores were excellent in 38 cases,good in 6 cases,fair in 3 cases and poor in 1 case.The excellent and good rate was 91.7%.No serious complications such as permanent nerve root injury,dural tear,infection or paravertebral hematoma occurred.Conclusions Percutaneous transforaminal endoscopic discectomy can effectively treat recurrent lumbar disc herniation.The symptoms and functions of the patients can be relieved and improved.