侧路经皮椎间孔镜技术在腰椎后路术后再次手术中的应用

目的:探讨侧路经皮椎间孔镜技术(transforaminal endoscopic spine system,TESSYS)在腰椎后路术后再次手术中的应用效果。方法:自2012年1月至2013年10月,根据纳入标准,筛选14例腰椎后路术后需要再次手术的患者,应用TESSYS治疗。其中男8例,女6例;年龄27～84岁,平均(50.4±18.9)岁。观察比较手术前后视觉疼痛模拟评分 (visual analogue scale,VAS)及日本骨科协会评分 (Japanese Orthopaedic Association Scores,JOA评分),并采用改良的Macnab标准评估疗效。结果:所有患者获得随访,时间6～27个月,平均18个月。术前及术后1周,3、6个月的VAS分别为6.79±1.31,2.50±1.29,2.21±1.53,1.64±1.08,术后与术前比较差异有统计学意义(P <0.01);JOA评分分别为12.43±1.95,21.50±3.78,21.93±4.55,23.36±4.33,术后较术前明显提高(P <0.01).按改良的Macnab 标准评定,优5例,良7例,可1例,差1例。1例穿刺过程中损伤L5神经根,其余患者无并发症。结论:选择合适的病例,在腰椎后路术后再次手术中应用TESSYS治疗,可以成功避开初次手术瘢痕,减少并发症,取得满意的临床效果。

Surgical revision of lumbar vertebrae using transforaminal endoscopic spine system

Objective:To explore the clinical effects of transforaminal endoscopic spine system in surgical revision of lumbar vertebrae. Methods:From January 2012 to October 2013,14 patients who needed reoperations of lumbar vertebrae were treated using transforaminal endoscopic spine system(TESSYS). There were 8 males and 6 males,aged from 27 to 84 years old with an average of(50.4±18.9) years. Visual analogue scale(VAS) and Japanese Orthopaedic Association Scores (JOA) were compared before and after surgical revision. Macnab standard was used to assess the clinical effect. Results:All the patients were followed up from 6 to 27 months with the mean of 18 months. Preoperative VAS score was 6.79±1.31,and in a week,3 months and 6 months after operation were 2.50±1.29,2.21±1.53,1.64±1.08,respectively,which were all much lower(P <0.01) than preoperative score. Preoperative JOA score was 12.43±1.95,and the above corresponding postoperative JOA scores were 21.50±3.78,21.93±4.55,23.36±4.33,respectively,which were all much higher than preoperative score(P <0.01). According to the modified Macnab criteria,5 patients got an excellent results,7 good,1 fair and 1 poor. The nerve root injury of L5 occurred in 1 case during paracentesis and no other complications were found. Conclusion:Selecting the appropriate indications using TESSYS in surgical revision of lumbar vertebrae can successfully avoid the operation scar,reduce the surgical complications and obtain satisfactory clinical outcomes.