经椎间孔入路经皮内窥镜下椎间盘切除术治疗腰椎椎间盘突出症

目的分析经椎间孔入路经皮内窥镜下椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗腰椎椎间盘突出症的疗效。方法回顾性分析2013年1月~2014年6月上海开元骨科医院与第二军医大学附属长征医院骨科行PETD治疗的腰椎椎间盘突出症患者临床资料78例。记录患者住院时间、手术时间、术中出血量及卧床时间。采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)及改良Mac Nab标准评定疗效。结果所有患者顺利完成手术,术后随访15~32个月,平均21个月。手术时间38~49 min,平均42 min;术中出血量20~150 m L,中位出血量38 m L;卧床时间10 h~3 d,中位时间1 d;住院时间2~8 d,中位住院时间6 d,术后疗效满意,未发生严重并发症。术后患者VAS评分和ODI均较术前降低,差异具有统计学意义(P0.01)。结论 PETD治疗腰椎椎间盘突出症安全、有效,短期疗效满意,具有手术时间短、出血少、恢复快等优点。

Treatment of lumbar disc herniation by percutaneous endoscopic transforaminal discectomy

Objective To evaluate the effect of percutaneous endoscopic transforaminal discectomy (PETD) in the treatment of lumbar disc herniation(LDH). Methods From January 2013 to June 2014, the data of 78 cases who suffered from LDH, but were cured by PETD were retrospectively analyzed. The hospitalization days, operation time, blood loss and lying-in-bed time were recorded. The visual analogue scale(VAS) scores, the Oswestry disability index (ODI) and the modified MacNab criteria were used to evaluate the curative effect. Results All the cases were operated on successfully. After mean 21 months(15-32 months) follow-up, the curative effect was satisfactory. The mean operation time was 42 min(38-49 min), and the median intraoperative blood loss was 38 mL(20-150 mL). The median lying-in-bed time was 1 d(10 h-3 d), and the median hospitalization days was 6 d(2-8 d). Postoperative VAS score and ODI were lower than those of preoperative; the difference was statistically significant(P<0.01). Conclusion The treatment of LDH with PETD is effective and safe. It has the advantages of less operation time, less bleeding and rapid recovery.