经椎间孔入路经皮内窥镜下椎间盘切除术治疗相邻节段退变型腰椎椎间盘突出症

目的探讨经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)治疗经椎间孔腰椎椎间融合术(TLIF)术后相邻节段退变(ASD)型腰椎椎间盘突出症的临床疗效。方法回顾性分析2012年12月—2014年12月同济大学附属第十人民医院脊柱外科行PETD治疗的28例TLIF术后相邻节段腰椎椎间盘突出患者的临床资料,记录手术时间,术中出血量,住院天数,术前、术后3个月、术后12个月及末次随访时腰部、下肢疼痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI),末次随访时采用Mac Nab标准评价临床疗效。结果所有手术均顺利完成,手术时间为(74.0±8.8)min,手术出血量为(32.6±6.8)m L,住院天数为(2.68±1.06)d,随访时间为(25.1±3.4)个月。术后3个月、术后12个月、末次随访时腰痛和下肢痛VAS评分及ODI与术前相比均有改善,差异均有统计学意义(P0.05)。根据Mac Nab标准,末次随访时患者临床疗效优良率为89.3%。结论 PETD治疗TLIF术后ASD型腰椎椎间盘突出症能够取得较为满意的疗效。

Percutaneous transforaminal endoscopic discectomy for treatment of adjacent segment degeneration lumbar disc herniation after transforaminal lumbar interbody fusion

Objective To investigate the clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) for treating adjacent segment degeneration (ASD) lumbar disc herniation after transforaminal lumbar interbody fusion (TLIF).Methods From December 2012 to December 2014, the clinical data of 28 cases of ASD lumbar disc herniation after TLIF treated with PETD were analyzed retrospectively.The operation time, intraoperative blood loss, length of stay, as well as low back and leg pain visual analogue scale (VAS) scores and Oswestry disability index (ODI) at pre-operation, postoperative 3 months, postoperative 12 months and final follow-up were recorded, respectively.MacNab criteria was used to assess the patient satisfaction at the final follow-up.Results All patients were operated successfully.The operation time was (74.0±8.8) min, and the intraoperative blood loss was (32.6±6.8) mL.The length of stay was (2.68±1.06) d, and the follow-up period was (25.1±3.4) months.The low back and leg pain VAS scores and ODI at postoperative 3 months, postoperative 12 months and final follow-up were all improved compared with those of the pre-operation;the difference was statistically significant (P<0.05).According to MacNab criteria, the excellent and good rate was 89.3%.Conclusion PETD could achieve satisfactory curative effect for ASD lumbar disc herniation after TLIF.