TESSYS技术治疗腰椎间盘突出症两年以上的临床疗效及相关影响因素分析  

Analysis of clinical efficacy and related influencing factors of TESSYS technique in treating lumbar disc herniation for more than two years

作　　者：贾忠雄 胡侦明[1] 张晓军[1] 江维[1] 沈皆亮[1] 周年[1] 郝杰[1] JIA Zhongxiong;HU Zhenming;ZHANG Xiaojun;JIANG Wei;SHEN Jieliang;ZHOU Nian;HAO Jie(Department of Orthopedics,First Affiliated Hospital,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,400016

出　　处：《重庆医学》2021年第14期2474-2477,共4页Chongqing medicine

摘　　要：目的探究经皮椎间孔镜下行脊柱系统(TESSYS)技术治疗腰椎间盘突出症(LDH)两年以上的临床疗效及相关影响因素。方法收集2015年8月至2018年5月因单节段LDH于该院行TESSYS手术治疗并获随访的53例患者的一般资料。随访时分别采用视觉模拟评分(VAS评分)和功能障碍指数(ODI)对患者术前和术后第1天、第1年、第2年及末次随访时的疼痛程度和腰椎功能进行评定。末次随访时应用改良Macnab标准对手术疗效进行评价。根据患者末次随访时的临床疗效,进行单因素分析和多因素logistic回归分析。结果53例患者均顺利完成TESSYS手术。与术前相比术后第1天、第1年、第2年和末次随访时的VAS评分和ODI评分均显著降低,差异有统计学意义(P<0.05)。末次随访时临床疗效为优良的41例,差可的12例,优良率77.36%。单因素分析显示,体力劳动强度为影响术后疗效的独立影响因素。多因素logistic回归分析显示,术后是否佩戴支具、体力劳动强度和突出类型均是导致患者术后临床疗效欠佳的高危因素。结论TESSYS技术治疗LDH两年以上的临床疗效确切,但应建议患者术后佩戴支具并从事低等级体力劳动。Objective To explore the clinical efficacy of TESSYS technique in the treatment of lumbar disc herniation for more than two years and its related influencing factors.Methods The general data of 53 patients with TESSYS surgical treatment due to single-segment lumbar disc herniation and follow up in this hospital from August 2015 to May 2018 were collected.The visual analog scale(VAS)and Owsestry disability index(ODI)were used to assess the patients′pain degree and lumbar vertebral function before operation,on postoperative 1 d,in postoperative 1 year,2 years and last follow-up respectively.The operation efficacy was evaluated with the modified Macnab standard at the last follow-up.The univariate analysis and multivariate logistic regression analysis were performed according to the clinical efficacy of the patients at the last follow-up.Results All 53 cases successfully completed the TESSYS operation.Compared with before operation,the VAS score and ODI score on postoperative 1 d,in postoperative 1,2 years and at the last follow-up were significantly reduced,with statistically significant differences(P<0.05).At the last follow-up,the excellent and good clinical efficacy was in 41 cases,12 cases were poor and fair,the excellent and good rate was 77.36%.The single factor analysis showed that physical labor intensity was an independent factor affecting the postoperative efficacy.The multivariate logistic regression analysis showed that wearing braces,physical labor intensity and protrusion type were the high risk factors leading to poor postoperative clinical efficacy.Conclusion The TESSYS technique in treating lumbar disc herniation for more than two years has definite clinical effect,but the patients should be advised to wear the braces and engage in low-grade physical work after surgery.

关 键 词：椎间盘移位 椎间孔镜 椎间孔入路 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]