经皮椎间孔镜TESSYS技术治疗腰椎融合术后相邻节段退变  

Transforaminal Endoscopic Surgical System in the treatment of adjacent segment degeneration after lumbar fusion

作　　者：刘祖耀[1] 李强[2] 李富[1] 王宏庆 李珂[1] 孙凤龙[1] LIU Zu-yao;LI Qiang;LI Fu;WANG Hong-qing;LI Ke;SUN Feng-long(Industrial Injury Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing 100144, China)

机构地区：[1]首都医科大学附属北京康复医院工伤康复中心 [2]首都医科大学附属北京康复医院骨科康复中心

出　　处：《中国临床研究》2019年第8期1049-1051,1055,共4页Chinese Journal of Clinical Research

摘　　要：目的对腰椎融合术后相邻节段退变患者采用经皮椎间孔镜技术治疗,观察椎间孔镜技术对此类患者的治疗效果。方法选取2014年8月至2017年11月行腰椎融合术后发生相邻节段退变的患者203例,采用经皮椎间孔镜技术进行治疗。收集所有患者临床资料,治疗前、出院时和治疗后3个月、6个月,采用视觉模拟评分(VAS)评价疼痛程度、Oswestry功能障碍指数问卷表(ODI)评分评价腰椎功能恢复情况、日本骨科协会评估治疗(JOA)评分评分评价腰椎功能改善情况,随访12个月,采用改良Macnab标准评价术后总体疗效。结果 203名患者的手术时间为(53.24±4.58)min,术中出血量为(10.20±1.05)ml,住院时间为(7.2±1.3)d。治疗后6个月2例患者失访。出院时、治疗后3个月、治疗后6个月患者的JOA评分、VAS评分及ODI指数均显著优于治疗前(P<0.01);且随时间延长,JOA评分逐渐增高,VAS评分、ODI指数逐渐降低,差异均有统计学意义(P<0.01)。术后1年,改良Macnab评价优为164例,良为21例,可为10例,差为6例,总优良率为92.04%。结论经皮椎间孔镜技术能够明显改善融合术后相邻节段退变的情况,减轻腰椎疼痛感,且患者术后腰椎功能恢复良好。Objective To observe and discuss the clinical effect of Transforaminal Endoscopic Surgical System ( TESSYS) in the treatment of patients with adjacent segment degeneration after lumbar fusion. Methods A total of 203 patients with adjacent segment degeneration after lumbar fusion who received TESSYS treatment from August 2014 to November 2017 were selected as study objects. Clinical data of all patients were collected. Visual Analogue Scale ( VAS) was used to evaluate the degree of pain, Oswestry Dysfunction Index ( ODI) was used to evaluate the recovery of lumbar spine function, and Japanese Orthopaedic Association ( JOA) score was used to evaluate the improvement of lumbar spine function before treatment, at discharge and 3 and 6 months after treatment. The patients were followed up for 12 months, and the overall outcome was evaluated by modified Macnab criteria. Results The operation time was (53. 24 ±4. 58) min, the amount of bleeding during operation was ( 10. 20 ± 1. 05) ml, and the duration of hospitalization was (7. 2 ± 1. 3 ) days. Two patients were lost to follow-up 6 months after treatment. The JOA score, VAS and ODI of patients at discharge, 3 months after treatment and 6 months after treatment were significantly better than those before treatment (P <0. 01 ). As time goes on, JOA score increases gradually, VAS score and ODI index decrease gradually ( P < 0. 01). One year after operation, 164 cases were excellent,21 cases were good,and 10 cases were good,6 cases were poor,the total excellent and good rate was 92. 04%. Conclusion TESSYS can significantly improve adjacent segment degeneration after fusion,relieve lumbar pain, and recover lumbar function well after operation.

关 键 词：经皮椎间孔镜TESSYS技术 相邻节段退变 腰椎融合术 视觉模拟评分 OSWESTRY功能障碍指数 日本骨科协会 

分 类 号：R68[医药卫生—骨科学]