椎间孔镜一孔多间隙处理多节段间盘突出的临床疗效观察

目的　探讨椎间孔镜一孔多间隙处理多节段腰椎间盘突出的临床疗效与安全性。 方法　统计自2014年1月至2018年5月多节段腰椎间盘突出患者共26例，均在局麻下采用经皮椎间孔镜一孔多间隙手术治疗，分别对患者进行术前、术后3个月、术后6个月、术后1年随访，观察患者治疗后的临床疗效及安全性，Oswestry功能障碍指数（ODI）、JOA评分、VAS评分、NaKai优良率。 结果　患者NaKai优良25例，术后复发1例，无效0例，总优良率为96.2%。术前 JOA评分（5.18±0.28）与术后1周 JOA评分（28.24±0.26），差异有统计学意义（P<0.01）。术前VAS评分（6.18±0.28），术后3个月评分（3.24±0.46），术后6个月评分（2.64±1.27），术后1年评分为（1.44±1.16）。术后3个月到1年VAS评分较术前评分明显降低，有统计学意义（P≤0.05）。ODI术前与术后差异有统计学意义（P<0.05）。术后26例患者下腰部疼痛及下肢麻木、疼痛均得到明显缓解，术中切口小，出血少，术后住院时间短，下床活动时间早，生活质量得到明显提高。 结论　经皮椎间孔镜一孔多间隙治疗多节段腰椎间盘突出，创伤小，安全有效，值得临床推广应用。

Clinical effect on the treatment of multi-level lumbar disc herniation with one hole percutaneous endoscopic technique

Objective To discuss the clinical curative effect and safety on the treatment for multi-level lumbar disc herniation with one hole percutaneous endoscopic technique. Methods 26 patients，from January 2014 to July 2018，diagnosed as multi-level lumbar disc herniation，were observed. All patients were treated with the one hole percutaneous endoscopic technique under the local anesthesia. The Oswestry disability index (ODI), visual analogue scale (VAS) and NaKai excellent rate preoperative，6 months after surgery and 1year after surgery were used to analyze clinical curative effect and security. Results 25 patients got NaKai excellent, 1 patient got relapse, and 0 patient inefficacy. Total NaKai excellent rate was 96.2%. VAS score was（6.18±0.28）preoperatively, (3.24±0.46) 3 months after surgery, and（2.64±1.27）6 months after surgery, and (1.44±1.16) 1 year after surgery. The VAS score was significantly lower than the preoperative score from 3 months to 1 year after surgery. The difference was statistically significant. The difference between preoperative and postoperative ODI was statistically significant（P<0.05）. Postoperative lumbar pain and lower limb numbness and pain were alleviated in 26 patients. Intraoperative small incision, less bleeding, short postoperative hospital stay, early time to go to the ground, and quality of life got improved. Conclusion Treatment of multi-segment lumbar disc herniation with one hole percutaneous endoscopic technique shares the advantage of being less traumatic, safe and effective, making it worthy of clinical application and promotion.