侧后路经皮椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛

目的探讨侧后路经皮椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛的短期疗效。方法采用侧后路经皮椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗25例经椎间盘造影证实的间盘源性腰痛,分析治疗前及治疗后6个月内VAS评分的变化及术后6个月MacNab评分。结果2例术后1周出现下肢日光烧灼综合征,均为L5～S1椎间盘破裂患者,经过脉冲电刺激治疗1周后缓解;无其他手术并发症发生。25例随访6～10个月,术前腰痛VAS评分为6.24±0.97,术后1周VAS评分0.80±0.65,术后1、3、6个月VAS评分均为0（0～2）,术后腰痛VAS评分较术前有明显降低（Kruskal-Wallis法秩和检验,H=61.680,P=0.000）,且术后6个月内腰痛VAS评分无明显反弹。术前伴有下肢疼痛不适的4例术后下肢症状均缓解。按照MacNab评分标准,6个月随访时11例优,12例良,2例可,优良率92.0%（23/25）。结论侧后路经皮椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗间盘源性腰痛短期疗效满意。

Transforaminal Posterolateral Endoscopic Discectomy and Radiofrequency Annuloplasty for Discogenic Low Back Pain

Objective To study the short-term outcome of transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in patients with discogenic low back pain. Methods A total of 25 patients with discogenic low back pain,who were diagnosed by provocative discography,received transforaminal posterolateral endoscopic discectomy and radiofrequency annuloplasty in our hospital. The VAS scores determined before and 6 months after the operation were compared in the patients. Their MacNab scores were also evaluated at 6 months postoperation. Results After the surgery,2 patients who had ruptured intervertebral discs （L5-S1） developed sunburn syndrome,and then was relieved by pulsed electrical stimulation for one week. The patients were followed up for 6-10 months,during which no other postoperative complications occurred. The mean VAS score of this series decreased significantly after the treatment,and kept being reduced in 6 months [preoperation：6.24±0.97,1,3,6 months after the operation：0（0~2）, Kruskal-Wallis rank-sum test,H=61.680,P=0.000]. Four patients showed lower limbs pain before the treatment and were relieved after the surgery. The evaluation of MacNab score showed excellent in 11 pateints,good in 12,and fair in 2,suggesting an effective rate of 92.0%（23/25）. Conclusions Transforaminal posterolateral endoscopic discectomy plus radiofrequency annuloplasty is effective for discogenic low back pain in a short term.