经皮穿刺椎间孔镜下应用TESSYS技术治疗 腰椎间盘突出症的临床疗效观察

目的 评估经皮穿刺椎间孔镜下采用TESSYS技术治疗椎间盘突出的短期临床疗效。方法 选择2017年1月~8月宁夏回族自治区第三人民医院采用椎间孔镜系统治疗腰椎间盘突出症62例，观察患者年龄、病程、手术时间、术后引流量、术后恢复情况，比较手术前后患者VAS、ODI、JOA评分。结果 62例患者手术顺利，无转为开放手术病例。平均手术时间（74.84±18.74）min，平均住院时间（8.52±1.52）d；随访3~6个月，术前、术后及末次随访时VAS评分分别为（8.20±1.14）分、（2.01±0.86）分和（1.13±0.64）分；JOA评分分别为（10.13±2.56）分、（22.57±1.69）分和（23.72±1.27）分；ODI评分分别为（40.46±5.55）分、（11.97±2.52）分和（9.13±1.48）分。术后3个月及末次随访时与术前比较，统计学意义显著（P＜0.01）。改良Macnab标准评价临床效果优56例，良5例，可1例。MacNab标准优良率达到98.39%。术后髓核残留1例，发生率为1.61%，术后复发3例，发生率为4.84%，术后神经根性痛觉过敏10例，发生率为16.13%，术后脑脊液漏患者2例，发生率为3.23%。59例患者末次随访时症状均无复发。结论 通过椎间孔镜下手术操作后，术后VAS、ODI、JOA与术前比较均显著改善，术中出血量较的传统手术有明显下降，微创手术缩短下地时间，降低了术后并发症的发生率，提高了患者的功能恢复的质量。

Clinical Observation of Percutaneous Lumbar Disc Herniation Treated by TESSYS Technique under Transforaminal Endoscopy

Abstract:Objective To evaluate the short-term clinical efficacy of percutaneous transforaminal use of TESSYS in the treatment of intervertebral disc herniation.Methods From January to August 2017,62 cases of lumbar disc herniation were treated by intervertebral foraminoscope system in Ningxia Third People's Hospital of Hui Autonomous Region.The patients'age,course of disease, operation time,postoperative drainage and postoperative recovery were observed. VAS,ODI and JOA scores were compared before and after operation.Results 62 patients underwent successful operation without conversion to open surgery.The average operation time was (74.84±18.74)min,the average hospital stay was(8.52±1.52)d;the follow-up period was 3-6 months,the VAS scores were(8.20±1.14), (2.01±0.86)and(1.13±0.64)before,after and at the last follow-up.The JOA scores were(10.13±2.56)and(22.57±1.69),respectively.The scores were(23.72±1.27);the ODI scores were(40.46±5.55),(11.97±2.52)and(9.13±1.48),respectively.At 3 months after the operation and at the last follow-up,statistically significant(P<0.01).The improved Macnab standard evaluation was excellent in 56 cases,good in 5 cases,and fair in 1 case.The excellent rate of MacNab standard reached 98.39%.1 case of residual nucleus pulposus was performed, the incidence rate was 1.61%,3 cases were recurred,the incidence rate was 4.84%,10 cases of postoperative radiculopathy hyperalgesia,the incidence rate was 16.13%,and 2 cases of postoperative cerebrospinal fluid leakage occurred.The rate is 3.23%. There were no recurrences in the symptoms of the 59 patients at the last follow-up.Conclusion After operation under the operation of the intervertebral foramen,the postoperative VAS,ODI,JOA and the preoperative comparison were significantly improved.The intraoperative blood loss was significantly lower than the traditional operation.The minimally invasive surgery shortened the time of the lowering of the ground and reduced the postoperative complications.The incidence of the disease improves the quality of the patient's functional recovery.