椎间孔镜技术治疗复杂类型腰椎间盘突出症

目的：探讨椎间孔镜（transforaminal endoscopic spine system, TESSYS）技术治疗复杂类型腰椎间盘突出症的疗效。方法采用TESSYS技术，对复杂型腰椎间盘突出症39例（50个椎间盘）进行治疗，其中极外侧突出13例，老年腰椎间盘突出并退变性椎间孔狭窄17例，青少年腰椎间盘突出9例。采用视觉模拟疼痛评分和改良MacNad标准评定手术疗效。结果腰痛及下肢放射痛VAS评分术前为（8.7±1.2）分，术后3 d为（3.5±1.4）分，末次随访（1.5±1.1）分；其差异有统计学意义（P<0.01），改良MacNad标准临床效果评定结果为优28例，良7例，可4例，优良率为90.23%。患者对疼痛缓解满意率为95.2%，至今无复发病例。结论脊柱TESSYS系统是治疗腰椎间盘突出症较为安全有效的新技术，具有创伤小，出血少，视野清晰，操作精准，术后恢复快，安全性能好，手术效果优良等优点。

The clinical efficacy of transforaminal endoscopic spine system on the treatment of special type lumbar disc herniation

Objective To investigate the clinical efficacy of TESSYS on the treatment of special type lumbar disc herniation. Methods 102 cases with lumbar disc hernation (50 discs)were treated by transforaminal endoscopic spine system from April 2011 to November 2012, including 39 cases of complex type (13 cases of extreme lateral, 17 cases of disc herniation and degenerative spinal transforaminal stenosis, 9 cases of adolescent disc herniation). The operation outcome was determined by visual analogue scale and modified MacNab criteria. Results The preoperative VAS scores were (8.7±1.2), the postoperative VAS scores were (3.5±1.4, 1.5±1.1) at day 3 and final follow-up respectively. There was significant difference between the preoperative and postoperative VAS scores (P< 0.01). According to modified MacNab standard, 28 cases obtained excellent result, 7were good, 1 was fair.In 4 cases, the excellent rate was 90.23%, satisfactory with the pain relief was in 95.2% patients. Conclusion lumbar disc herniation can be safe and efficacious treated with TESSYS, which has the advantages of less invasive, few bleeding, clear operative vision, accurate operative procedure, quick recovery, better safety and outcome.