经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症的疗效观察

目的:评价应用经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症的疗效观察。方法:自2010年9月~2011年12月间,应用经皮椎间孔脊柱内窥镜下技术,治疗腰椎间盘突出症277例(340个椎间盘)。采用患者腰腿痛进行视觉模拟疼痛评分(visual analogue scale,VAS)和Macnab标准评定手术疗效。结果:本组无术中硬脊膜撕裂和血管、神经损伤等并发症。3例患者术后下肢表现一过性痛觉过敏,经对症治疗2周后症状消失。平均手术时间45 min(30~70 min),平均下床时间6 h(3~12 h),平均住院时间7 d(5~15 d),随访时间4~13个月,平均6.8个月。下肢神经支配区域使用VAS评分,术前8.8±1.0分,术后5 d为2.5±1.4分,末次随访时1.3±1.2分;术前、术后对比,结果有统计学差异(P<0.01)。参照Macnab疗效评定标准,优211例,良54例,可12例,差0例,优良率95.8%。结论:经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症具有创伤小、出血少、恢复快、并发症少、疗效确切的优点。该技术是微创治疗腰椎间盘巨大突出、脱出、游离型椎间盘突出症的最佳方法之一。

THE CLINICAL EFFICACY OF PERCUTANEOUS TRANSFORAMINAL LUMBAR SPINAL ENDOSCOPIC TECHNIQUE ON THE TREATMENT OF LUMBAR DISC HERNIATION

Objective: To evaluation the clinical efficacy of percutaneous transforaminal lumbar spinal endoscopic technique on the treatment of lumbar disc herniation.Methods: From 2010 September-2011 December,277 cases(340 discs) with lumbar intervertebral disc herniation were treated with percutaneous transforaminal lumbar spinal endoscopic technique.Visual analogue scale(VAS) of low back and leg pain and Macnab standard were used to evaluate the curative effect.Results: No complication was observed after operation,such as intraoperative dural tear and blood vessels,nerve injury.Transient hyperalgesia was observed in 3 patients after lower limb performance,and the symptoms was disappeared after 2 weeks symptomatic treatment.The average operation time was 45 min(30 ~ 70 min),the average bed time was 6 h(3 ~ 12 h),the average hospitalization time was 7 d(5 ~ 15 d),the average follow-up time was 6.8 months(4 ~ 13 months).The VAS score before operation,5 d after operation and the last follow-up time were 8.8 ± 1.0,2.5 ± 1.4,1.3 ± 1.2 respectively.There were statistically significant differences between before and after operation(P < 0.01).According to Macnab criteria for assessment of therapeutic effects,excellent in 211 cases,good in 54 cases,fair in 12 cases,poor in 0 cases,the excellent and good rate was 95.8%.Conclusion: Percutaneous transforaminal lumbar spinal endoscopic technique was an effective the treatment for lumbar disc herniation,with the advantages of less trauma and bleeding,rapid recovery and fewer complication and the technique is one of the best minimally invasive treatment for huge lumbar disc protrusion,prolapse,free type lumbar disc herniation.