经椎间孔脊柱内窥镜系统治疗椎间盘源性腰痛  

Transforaminal endoscopic spine system for treatment of discogenic low back pain

作　　者：祝建光[1] 潘福敏[1] 巴兆玉[1] 刘忠汉[1] 于彬[1] 吴德升[1] ZHU Jian-guang;PAN Fu-min;BA Zhao-yu;LIU Zhong-han;YU Bin;WU De-sheng(Deparlment of Spine Surgery, East Hospital,TongjiUniversity, Shanghai 200120, China)

机构地区：[1]同济大学附属东方医院脊柱外科,上海200120

出　　处：《脊柱外科杂志》2016年第6期330-334,共5页Journal of Spinal Surgery

基　　金：国家自然科学基金面上项目资助(81371994);上海市卫生和计划生育委员会科研课题资助项目(20134247);浦东新区卫生系统重点学科建设资助(PWZx2014-02)

摘　　要：目的探讨经椎间孔脊柱内窥镜系统（TESSYS)治疗椎间盘源性腰痛（DLBP)的疗效及其预后影响因素。方法回顾性分析2012年1月一2015年12月在本院脊柱外科就诊的慢性腰痛患者临床资料，按照入选标准，共58例DLBP患者入选，均接受TESSYS治疗。患者手术前后的腰痛情况和腰椎功能用疼痛视觉模拟量表（VAS)评分和Oswestry功能障碍指数（0DI)评估，评估末次随访时疗效用改良MacNab标准。结果所有患者随访6—48个月，平均24.5个月。患者术前腰痛VAS评分为（6.8±2.3)分，术后即刻为（3.5±1.4)分，末次随访为（1.2±0.9)分，各时间点间差异均有统计学意义〇P<0.05);术前OD1为（33.7±3.6)%，术后即刻为（18.6±2.9)%，末次随访为（9.3±1.8)%，各时间点间差异均有统计学意义〇P<0.05)。52例患者术中可见散在炎性病灶，其中22例仅有纤维环破口处炎性灶，另30例尚有硬膜囊腹侧、后纵韧带表面散在炎症灶，且对炎性病灶刺激后可以复制疼痛。此52例患者末次随访时临床疗效优良率为78.8%,显著高于余6例患者的33.3%,差异有统计学意义〇P<0.05)。结论TESSYS是治疗DLBP的有效手段，术中对纤维环破口处、椎管内后纵韧带和硬膜囊等椎间盘外组织上的炎性病灶的热凝处理，可以提高疗效。Objective To observe the clinical efficacy of transforaminal endoscopic spine system (TESSYS) for the treatment of discogenic low back pain (DLBP) . Methods A total of 58 DLBP patients meeting the inclusion criteria from January 2012 toD ecem ber 2015 were involved in this retrospective research. The efficacy ofTESSYS was assessed by visual analogue scale (VAS)score for low back pain, and the Oswestry disability index (O D I) for functional recovery. The modified MacNab criteria was usedto assess the surgical results at the final follow-up. Results The follow-up t h e was 2 4 .5 ± 9 .8 m o nths, ranged 6-48 months. VASscore was 6 .8 ± 2 .3 at pre-operation,3 .5 ± 1 .4 immediately post-operation, and 1 .2 ± 0 .9 at the final follow-up; the d ifference wasstatistically significant at all tm e points ( P < 0.05) . ODI was ( 3 3 . 7 ± 3 . 6 ) % at pre-operation,( 1 8 . 6 ± 2 . 9 ) % at immediatelypost-operation, and ( 9 . 3 ± 1 . 8 ) % at the final follow-up; the difference was statistically significant at all tm e points ( P < 0 .0 5 ).Sporaic inflammation lesions were observed in 52 patients, inflammation on annulus fibrosus rent in 22 and on the ventral s d e ofthe dural sac and the surface of the posterior longitud inal ligamentin addition to the annulus fibrosus rent in 30. The pain could bereplicated after stimulation to the inflammatory lesion. The effectiveness rate was 78.8% at the final follow-up in the 52 patients,wh ich was significantly higher than that in the other 6 patients ( P < 0.05) . Conclusion TESSYS is an effective means for treating DLBP. Heat coagulation m anagem ent of inflammatory lesions on the annulus fibrosus, posterior longitudinal ligam ent or dura sac can enhance the therapeutic efficacy of TESSYS.

关 键 词：椎间盘炎 腰痛 内窥镜检查 计算机辅助设计 外科手术 微创性 

分 类 号：R683.2[医药卫生—骨科学]