经皮椎间孔镜技术治疗腰椎间盘突出症  

Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation

作　　者：许天明[1,2] 倪斌[1] 王魁[2] 邵擎东[2] 严旭[2] 蒋贵成 吕凤霞[2] 

机构地区：[1]第二军医大学附属长征医院脊柱外科,上海200003 [2]解放军第455医院骨科,上海200052

出　　处：《颈腰痛杂志》2016年第3期186-190,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的研究经皮椎间孔镜技术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症的临床疗效及安全性。方法回顾性研究2012-01-2014-04接受PTED治疗的122例单节段伴有单侧神经根性症状的腰椎间盘突出症患者的临床资料,其中L_(3-4)19例,L_(4-5)68例,L_5-S_1 35例。A组97例采用经椎间孔入路TESSYS技术,B组25例采用YESS技术。记录手术时间、术中疼痛视觉模拟评分(VAS评分)及并发症情况,采用VAS评分、0swestry功能障碍指数(ODI)、MacNab疗效评定标准评定疗效。结果所有患者均完成手术,A组有1例出现神经根损伤。其他患者未发生严重神经、血管损伤等严重并发症。平均手术时间A组大于B组,差异有统计学意义(P<0.05)。A组术中疼痛VAS评分小于B组,差异有统计学意义(P<0.05)。7例术后3个月内下肢疼痛明显,其中A组4例,B组3例,在术后半年内再次行腰椎后路融合手术。两组术后3d和末次随访时腰痛、腿痛VAS评分显著低于术前,差异有统计学意义(P<0.05),两组之间差异无统计学意义(P>0.05)。两组末次随访时ODI指数均低于术前,差异有统计学意义(P<0.05),两组之间差异无统计学意义(P>0.05)。末次随访时疗效按MacNab标准评定,优良率76.0%,差异没有统计学意义(P>0.05)。结论经皮椎间孔镜下腰椎间盘髓核摘除术治疗腰椎间盘突出症安全有效,创伤小,恢复快。严格把握手术适应证前提下,经椎间孔入路YESS技术和TESSYS技术都能达到很好的疗效,但TESSYS技术适应证更广。Objective To study the clinical effect and safety of percutaneous trasforaminal endoscopic discectomy （FILED） for lumbar disc herniation. Methods From Jan 2012 to Apr 2014, 122 patients with single level unilateral radicular pain were retrospectively reviewed, of which 19 protrusions were at L3-4, 68 at L4-5, 35 at Ls-Sl, respectively. 97 patients were treated with TESSYS technique （group A） the other 25 patients were treated with YESS technique （group B）. The surgery times, intraoperative visual analog scale （VAS）scores and complications were recorded; the outcomes were compared with VAS score, Oswestry disability index （ODI） and modified Macnab criteria. Results All patients received surgeries successfully except for 1 case in group A suffering nerve injury. No neurological or vascular complications occurred to other patients. The mean surgery time of group A is longer than that of B, with significant statistical difference （P〈 0.05）. The intraoperative VAS scores of group A is less than that of B,with significant statistical difference （P〈0.05）. There were 7 cases （4 in group A,3in group B）complaining of severe pain inthe leg in 3 month postoperatively and received posterior lumbar fusion surgeries in 6 month after initial treatment. The VAS scores of pain in the back and leg at 3 day postoperatively and final follow-up are markedly less than preoperative ones in group A and B, respectively, with significantstatistical difference（P〈0.05）. The ODI indexes at final follow-up are less than preoperative ones in group A and B, respectively, with significant statistical difference （P〈0.05）, but no statistical difference between group A and B （P〉0.05）. The satisfactory rate of group A and B was 84.5% and 76.0% respectively,with no significant statistical difference （P〉0.05）. Conclusions PTED is effective and safe in treating lumbar disc herniation, with minimal invasiveness and fast recovery. YESS and TESSYS techniques can both achieve satisfactory efficacy

关 键 词：腰椎间盘突出症 经皮椎间孔镜技术 TESSYS技术 YESS技术 

分 类 号：R681.53[医药卫生—骨科学]