经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症

[目的]评估经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出症的临床疗效。[方法]2009年1月～2010年12月,新桥医院骨科采用椎间孔镜系统治疗腰椎间盘突出症245例,并与同期采用椎间盘镜系统(MED)治疗腰椎间盘突出症216例进行对比研究。观查手术时间、术中出血量、手术切口长度,采用视觉模拟评分法(VAS)评估手术前后患者腰腿疼痛缓解的情况,改良Macnab评分评估患者术后腰部功能恢复的情况,阅卷方式评估患者术后的满意度。[结果]两组病例术前VAS评分分别为(7.6±2.2)、(7.3±1.9),两者无显著性差异(P>0.05),术后VAS评分分别为(2.8±1.3)、(2.4±1.7),两者病例术后VAS评分分别与术前比较均有明显改善(P<0.05),两组之间术后VAS评分比较无显著性差异(P>0.05)。两组病例手术时间分别为(54.8±10.4)min、(60.5±15.8)min,两组比较无显著性差异(P>0.05);两组病例术中出血量分别为(81.5±20.7)ml、(9.5±4.7)ml,两组比较有显著性差异(P<0.05);两组病例手术切口长度分别为1.8 cm、0.8 cm,两组比较有显著性差异(P<0.05);两组病例Macnab评分分别为97%、95%,两组比较无显著性差异(P>0.05)。[结论]经皮椎间孔镜下TESSYS技术经椎间孔镜入路行椎间盘髓核摘除术是治疗腰椎间盘突出症的一种有效方法,具有手术切口更小、术后疼痛轻,可以早期下地活动、术后恢复更快等优点。

Surgical treatment of the lumbar disc herniated discs using transforaminal endoscopic surgery system

[Objective] To evaluate the clinical efficacy of transforaminal diskectomy using TESSYS(transforaminal endoscopic surgery system)technique in patients with the lumbar disc herniation.[Methods]From 2004 to 2006,245 patients with lumbar disc herniation were treated in Department of Orthopedics in Xinqiao Hospital.The clinical data and results were analyzed and compared with 216 patients treated with MED technique.The operation time,intraoperative blood loss and length of incision were all recorded.VAS scores and Macnab criteria were employed to evaluate the clinical results.[Results]Preoperative VAS scores were(7.6±2.2) and(7.3±1.9) for TESSYS and MED,with no significant difference(P>0.05).Postoperative VAS scores were(2.8±1.3) and(2.4±1.7) in TESSYS and MED groups respectively,which showed significant improvement compared with preoperative score,but no significant difference between the two groups.Operation time was(54.8±10.4) and(60.5±15.8) minutes with no significant difference(P>0.05).Intraoperative blood loss was(81.5±20.7) ml in MED group and(9.5±4.7) ml in TESSYS group,with significant reduction for the latter.Length of incision was 1.8 cm and 0.8 cm in MED and TESSYS groups,with significant difference.Modified Macnab criteria indicated a similar satisfactory rate of 97% and 95%.[Conclusion]Transforaminal discetomy using TESSYS technique is an efficient technique for lumbar disc herniation,with prominent advantages of minimal incision,less postoperative pain,early immobilization and fast recovery.