应用椎间孔镜TESSYS技术治疗腰椎间盘突出症

目的评估经皮椎间孔镜(transforaminal endoscopic spine system,TESSYS)技术治疗腰椎间盘突出的临床疗效,总结临床经验。方法 2010年8月～2011年5月应用经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症患者42例,其中男22例,女20例,患者平均年龄39.5岁(20岁～67岁),平均病程11个月(3个月～6年)。所有患者均为单间隙突出,突出间隙:L3/4 3例,L4/5 26例,L5/S1 13例。手术效果按照视觉疼痛模拟评分(visual analogue scale,VAS)、JOA评分(Japanese OrthopaedicAssociation Scores)、0swestry功能障碍指数(0swestry disability index,ODI)和改良MacNab标准进行评定。结果所有患者均成功实施手术。平均手术时间70 min(55～120min),术中出血量5～15 mL。术后3例患者出现下肢神经感觉异常;3例患者术后症状即刻缓解,出院后症状加重;1例患者术后症状缓解不明显,所有患者均经保守治疗后恢复正常或症状好转。无患者出现感染、血管、神经损伤和硬脊膜破裂等合并症。术后随访时间9个月。腰痛、腿痛VAS评分由术前(5.8±1.4)分、(7.4±2.2)分减少到术后9个月时的(1.6±0.9)分、(1.4±0.2)分,术后不同随访时间点VAS评分与术前比较明显改善(P<0.05)。JOA评分由术前(12.1±3.7)分升高至术后9个月时的(22.5±2.1)分,ODI由术前(68.83±14.18)%下降至术后9个月时(21.02±11.34)%。根据改良MacNab标准,术后末次随访时优12例(28.6%),良25例(59.5%),可4例(9.5%),差l例(2.4%),优良率88.1%。结论经皮椎间孔镜TESSYS技术是治疗腰椎间盘突出症安全、有效的手术方法。

Transforaminal endoscopic spine system in percutaneous transforaminal endoscopic discectomy for lumbar disc herniation

Objective To evaluate the efficacy of the transforaminal endoscopic spine system(TESSYS) percutaneous transforaminal endoscopic technique for treatment of lumbar disc herniation. Methods From August 2010 to May 2011, 42 cases of lumbar disc herniation with average age of 39.5 years(range, 20~62 years) who underwent percutaneous endoscopic surgery were included in this retrospective study. Of the 42 cases, 22 were males and 20 females.The mean course of disease was 11 months(range, 3 months~6 years). The involved segments were L3/4 in 3 cases, L4/5 in 26 cases, and L5/S1 in 13 cases. The surgery was performed under local anesthesia. The visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) Scores, Oswestry disability index(ODI) and modified MacNab criteria were employed to measure the clinical outcome. Results The operation was successful in all the cases. The mean operation time was 70 min(range, 55~120 min) with the blood loss of 5~15 mL. Only 3 cases were found complicated with transient paraesthesia in lower limbs. Another 3 cases suffered from leg pain recurrence after relief and 1 case had no significant relief. All these problems were relieved after the conservative treatment. There were no infection, dural matter tear and intraoperative neurovascular injury in any of the cases. The mean follow-up period was 9 months. The preoperative mean VAS of low back and leg pain decreased from (5.8±1.4) and (7.4±2.2) points to (1.6±0.9) and (1.4±0.2) points at 9th month postoperatively. The JOA scores increased from (12.1±3.7) to (22.5±2.1) points while the ODI decreased from (68.83±14.18)% to (21.02±11.34)%. The effects were excellent in 12(28.6%) cases, good in 25(59.5%) cases, fair in 4(9.5%) and poor in 1(2.4 %) according to modified MacNab criteria with the sum of excellent and good rate up to 80.1%. Conclusion As an effective minimally invasive treatment for lumbar disc herniation, TESSYS percutaneous transforaminal endoscopic technique for lumbar discectomy can ensure reliable clinical outcome with less complications, early functional recovery and good prognosis.