经皮内镜椎间孔入路腰椎间盘切除术并发硬脊膜撕裂的综合处理及疗效分析

目的 探讨经皮内镜椎间孔入路腰椎间盘切除术（PETD）治疗腰椎间盘突出症并发硬脊膜撕裂的处理方法及预后。方法 回顾性分析2016年3月至2017年1月采用PETD治疗的236例腰椎间盘突出症的病例资料。结果 236例中，3例发生硬脊膜撕裂，发生率为1.3%(3/236)。2例术中诊断，其中1例术中转为显微镜下修补硬脊膜，1例术中未做处理；1例术后诊断，在显微镜下完成硬脊膜修补。3例随访12个月，末次随访时视觉模拟量表评分从术前8.0分降至1.7分，Oswestry功能障碍指数从82.1%降至17.8%，均无神经功能障碍等后遗症；改良MacNab评分2例为优，1例为良。结论 硬脊膜撕裂是PETD较为少见的并发症，应根据术中和术后情况，采取综合治疗措施，总体预后良好

Management and outcomes of dural tears during percutaneous endoscopic transforaminal lumbar discectomy for patients with lumbar disc herniation

Objective To investigate the treatment method and outcomes of dural tear during percutaneous endoscopic transforaminal lumbar discectomy (PETD) for the patients with lumbar disc herniation (LDH). Methods A retrospective analysis was performed in 236 patients with LDH treated with PETD from March 2016 to January 2017. Visual analogue scale (VAS), Oswestry disability index (ODI) and modified MacNab criteria were used to evaluate clinical outcomes. Results Of thsee 236 patients, 3 (1.3%, 3/236) patients suffered from dura tear during the operation. Two patients were diagnosed intraoperatively, of whom 1 patient was switched to repairing the dura under the microscope, and 1 did not treated during the operation. One patient was diagnosed after the surgery, whose dura was repaired under the microscope. Three patients were followed up for 12 months. At the last follow-up, the VAS score was reduced from 8.0 points before surgery to 1.7 points after surgery. The ODI was reduced from 82.1% to 17.8%. There were no neurological dysfunction. Based on the modified MacNab criteria, excellent results were obtained in 2 patients and good in 1. Conclusions Dural tear is a rare complication of PETD. Comprehensive treatment should be taken according to the intraoperative and postoperative conditions. The overall prognosis of dural tear is favorable