经椎间孔脊柱内窥镜系统治疗腰椎椎间盘突出症的临床疗效及对腰椎活动度的影响  

Clinical efficacy of transforaminal endoscopic spinal system for lumbar disc herniation and its impact on lumbar range of motion

作　　者：李清 臧乐源 陈萧萧 蒋传海 夏永刚 Li Qing;Zang Leyuan;Chen Xiaoxiao;Jiang Chuanhai;Xia Yonggang(Second Department of Orthopaedics,Suzhou BOE Hospital,Suzhou 215000,Jiangsu,China;Second Department of Orthopaedics,No.901 Hospital of Joint Logistics Support Force of Chinese PLA,Hefei 230000,Anhui,China;Department of Orthopaedics,Huainan Oriental Hospital Group,Huainan 232000,Anhui,China)

机构地区：[1]苏州京东方医院骨二科,苏州215000 [2]中国人民解放军联勤保障部队第九〇一医院骨二科,合肥230000 [3]淮南东方医院集团骨科,淮南232000

出　　处：《脊柱外科杂志》2025年第2期114-118,共5页Journal of Spinal Surgery

摘　　要：目的探讨经椎间孔脊柱内窥镜系统(TESSYS)治疗腰椎椎间盘突出症(LDH)的临床疗效及对腰椎活动度(ROM)的影响。方法回顾性分析2020年10月—2023年9月3所医院收治的106例LDH患者临床资料,其中53例采用椎板开窗椎间盘切除术治疗(FD组),另53例采用TESSYS治疗(TESSYS组)。比较2组术后7 d疼痛和炎性因子[P物质(SP)、血清神经肽Y(NPY)、肿瘤坏死因子-α(TNF-α)及单核细胞趋化蛋白-1(MCP-1)]水平,及术后3个月腰椎ROM(直腿抬高角度和腰椎后伸、前屈、左右侧曲角度)。采用改良MacNab标准评价临床疗效,并记录并发症发生情况。结果所有手术顺利完成,所有患者随访时间>3个月。术后7 d,2组疼痛与炎性因子水平较术前下降,且TESSYS组疼痛与炎性因子水平低于FD组,差异均有统计学意义(P<0.05)。术后3个月,2组腰椎ROM均较术前改善,且TESSYS组改善情况优于FD组,差异均有统计学意义(P<0.05)。术后3个月改良MacNab标准评价疗效,FD组疗效优良率为61.2%,TESSYS组疗效优良率为83.1%,差异有统计学意义(P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论TESSYS治疗LDH可降低疼痛和炎性因子水平,改善腰椎ROM,疗效优良,且手术安全性较高,值得临床推广应用。Objective To investigate the clinical efficacy of transforaminal endoscopic spinal system(TESSYS)for lumbar disc herniation(LDH)and its impact on lumbar range of motion(ROM).Methods From October 2020 to September 2023,the clinical data of 106 LDH patients admitted to 3 hospitals were retrospectively analyzed,including 53 cases treated with fenestrated discectomy(FD group),and the other 53 cases treated with TESSYS(TESSYS group).The levels of pain and inflammatory factors(substance P[SP],neuropeptide Y[NPY],tumor necrosis factor-α[TNF-α],monocyte chemoattractant protein-1[MCP-1])at postoperative 7 d,as well as the lumbar ROM(angle of straight leg raising,and lumbar extension,flexion and right and left bending)at postoperative 3 months were compared between the 2 groups.The modified MacNab criteria was used to evaluate the clinical efficacy,and the occurrence of complications was recorded.Results All the surgeries were successfully completed,and all the patients were followed up for more than 3 months.At postoperative 7 d,the levels of pain and inflammatory factors in both groups decreased compared to the preoperative levels,and the pain and inflammatory factor levels in the TESSYS group were lower than those in the FD group,all with a statistically significant difference(P<0.05).At postoperative 3 months,both groups showed an improvement in lumbar ROM compared to the preoperative levels,with the TESSYS group showing better improvement than the FD group,and the differences were statistically significant(P<0.05).At postoperative 3 months,according to the modified MacNab criteria,the good and excellent efficacy rate of FD group was 61.2%,and 83.1%of TESSYS group,with a statistically significant difference(P<0.05).There was no statistically significant difference in the incidence of complications between the 2 groups(P>0.05).Conclusion The use of TESSYS in the treatment of LDH can reduce pain and inflammatory factor levels,improve lumbar ROM,have excellent therapeutic effects,and have high surgical safety,thus being

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 经皮 外科手术 微创性 

分 类 号：R681.531[医药卫生—骨科学]