椎间孔镜下靶点穿刺治疗游离脱垂型腰椎间盘突出症的临床疗效分析

目的 探讨经侧入路椎间孔镜下靶点穿刺治疗游离脱垂型腰椎间盘突出症（LDH）的安全性及有效性。方法 采用回顾性分析方法，选取2016年6月—2018年6月西安交通大学第一附属医院采用靶点穿刺技术经侧入路椎间孔镜下治疗的26例游离脱垂型腰椎间盘突出症患者。记录手术时间、住院时间、术后并发症、背部和下肢视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、手术前后影像学资料等。随访时间≥ 1年。比较术前、术后3个月、术后1年、末次随访时背部疼痛VAS评分、下肢疼痛VAS评分及ODI的变化，并进行统计学分析。结果 26例患者平均年龄（39.269±10.352）岁，平均体重指数（BMI）（22.731±2.127）kg/㎡，平均随访时间（18.192±2.669）个月，平均住院时间（3.577±0.902）d，平均手术时间（72.521±15.232）min，术中平均出血量（10.013±3.004）ml。术后3个月、术后1年、末次随访背部疼痛VAS评分、下肢疼痛VAS评分及ODI与术前比较，差异有统计学意义（P <0.05）。术后无脑脊液漏、神经损伤、感染等并发症发生。术后复查磁共振成像证实游离脱出的髓核组织均已被摘除。1例患者于术后1年出现复发，再次行椎板间入路摘除突出髓核，术后恢复良好。结论 经侧入路椎间孔镜下靶点穿刺治疗游离脱垂型LDH具有满意的临床疗效，且安全性较高。

Application of target puncture technique in treatment of free prolapse type lumbar disc herniation under percutaneous endoscopic transforaminal discectomy

Objective To explore the safety and effectiveness of target puncture technology in the treatment of free prolapsed lumbar disc herniation (LDH) under the lateral approach foraminal.Methods A retrospective analysis method was used to summarize the clinical data of patients with free prolapse type lumbar disc herniation treated with target puncture technology and percutaneous endoscopic transforaminal discectomy from June 2016 to June 2018. The operation time, hospital time, postoperative complications, visual analogue scale (VAS) of back pain, leg pain, Oswestry disability index (ODI), postoperative complications, imaging data before and after surgery were recorded. Follow-up time is not less than 1 year. Statistical analysis were used with the changes of VAS score and ODI index of low back pain and leg pain at the last follow-up were compared before operation, 3 months after operation, and 1 year after operation, respectively.Results All 26 patients were followed up, including 14 males and 12 females. The average age was (39.269 ± 10.352) years, the average body mass index (BMI) was (22.731 ± 2.127) kg/m², the average follow-up time was (18.192 ± 2.669) months, and the average hospital stay was (3.577 ± 0.902) days. The operation time was (72.521 ± 15.232) mins, and the intraoperative blood loss was (10.013 ± 3.004) ml. At 3 months, 1 year, and the last follow-up, the VAS score of low back pain and VAS score of lower extremity pain were significantly different from those before surgery (P < 0.05). The ODI scores at 3 months, 1 year, and the last follow-up, were statistically different from those before surgery (P < 0.05). No complications occurred, such as cerebrospinal fluid leakage, nerve injury, and infection. Re-examination of Magnetic Resonance Imaging (MRI) after surgery confirmed that all the free nucleus pulposus tissue had been removed. One patient had recurrence 1 year after the operation. The interlaminar approach was performed again to remove the prominent nucleus pulposus, and the postoperative recovery was satisfactory.Conclusions Targeted puncture technique can be used to obtain satisfactory clinical efficacy and safety in the treatment of free prolapse type LDH by lateral approach.