经椎间孔入路内窥镜技术治疗多间隙腰椎间盘突出症的探讨

目的探讨经椎间孔入路应用内窥镜技术治疗多间隙腰椎间盘突出症的适应证、责任节段确认方法、手术特点及临床转归。方法回顾性分析2011年6月至2014年6月32例应用经皮穿刺椎间孔入路内窥镜技术治疗多间隙腰椎间盘突出症患者的资料。所有患者手术均在局部麻醉下完成，术中采用神经根牵拉试验验证手术效果并确定责任间隙。比较患者末次随访时与术前的疼痛视觉模拟量表（visual analogue scale, VAS）评分和Oswestry功能障碍指数（Oswestry disability index，ODI），并采用Macnab评价标准评价患者的功能恢复情况。结果随访12~38个月，平均26.5个月。患者术前腿痛及腰痛的VAS评分分别为（6.6±1.9）分、（3.3±1.6）分，ODI为（68.9±15.0）%。患者末次随访时的腿痛及腰痛VAS评分分别为（0.7±0.7）分、（0.6±0.7）分，ODI为（14.6±5.4）%，与术前比较差异均有统计学意义（均P＜0.05）；Macnab评价标准评价，优20例，良9例，中2例，差1例，优良率为90.6%。结论经椎间孔入路应用内窥镜技术可以有效处理多间隙腰椎间盘突出症，术前诊断及定位非常重要，多数邻近的2个间隙突出可以设计单切口完成，局部麻醉术中的神经根牵拉试验可以作为最后明确责任间隙的保障。

Treatment of multi-level lumbar disc herniation with percutaneous endoscopic technique through transforaminal approach

Objective To analyze the indication, identity of responsibility segment, operation details and clinical outcome of treatment of multi?level lumbar disc herniation by percutaneous transforaminal endo?scopic technique. Methods A retrospective study, from June 2011 to June 2014, involved 32 cases of multi?level lumbar disc herniation treated with percutaneous transforaminal endoscopic technique was performed. All procedures were performed under local anesthesia. The intra?operation straight leg raise test was applied not on?ly to confirm the effect of decompression around nerve root, but make sure the responsibility segment again. The visual analogue scale (VAS) and Oswestry disability index (ODI) in final follow?up were recorded to compare with the preoperative data and Macnab criteria was applied to evaluate the functional recovery. Results The mean follow?up time was 26.5 months (12?38 months). The preoperative VAS scores of low back pain and the sciatica were 6.6 ± 1.9 and 3.3 ± 1.6, and the preoperative ODI was (68.9 ± 15.0)%. The VAS scores of low back pain and the sciatica were 0.7 ±0.7 and 0.6±0.7 respectively, and the ODI was (14.6±5.4)%in the final follow?up. There was statistically significant difference preoperation and postoperatin. Excellent and good rate was 90.6%according to Macnab (20 in excellent, 9 in good, 2 in fair and 1 in bad). Conclusion It is effective to deal with the multi?level lumbar disc herniation by percutaneous transforaminal endoscopic technique. The ac?curate diagnosis and precisely locating responsibility segment were extremely important. The case which in?volved two consecutive segments could be performed in one incision. The intra?operation straight leg raise test plays an important role in determining the responsibility segment eventually.