经皮椎间孔内窥镜下手术治疗腰椎间盘突出症的近期疗效观察

Priliminary outcomes of percutaneous transforaminal endoscopic lumbar discectomy for lumbar disc herniation

中文关键词:  腰椎间盘突出症  经椎间孔  内窥镜  椎间盘切除术

英文关键词:Lumbar disc herniation  Transforaminal  Endoscope  Discectomy

中文摘要:

  【摘要】 目的：评价经皮椎间孔内窥镜下椎间盘切除术治疗腰椎间盘突出症的近期临床效果。方法：2009年9月～2010年3月应用经皮椎间孔内窥镜下椎间盘切除术治疗30例腰椎间盘突出症患者，男19例，女11例，年龄18～60岁，平均40.8岁；病程3个月～4年，平均9个月。术前患者均表现为腰痛伴单侧下肢放射性疼痛，均为单间隙突出，侧方型突出25例，旁中央型突出5例。均采用局部麻醉下手术。术前、术后不同时间对患者腰、腿痛进行VAS评分；采用Oswestry功能障碍指数（ODI）评估腰椎功能改善情况；术后6个月随访时采用Mac?鄄Nab标准评价疗效。结果：30例患者均成功实施手术，手术时间55～135min，平均75min，术中出血5～30ml，平均12ml。术后第二天戴腰围下地行走。1例术后患侧膝反射减弱；1例术后腰痛缓解，出院后腿痛加重，均经保守治疗后恢复正常或症状缓解。随访6～12个月，平均9.2个月。腰痛、腿痛VAS由术前的平均6.5分、8.7分下降到术后6个月时的1.9分、1.5分，与术前比较均有显著性差异﹙P＜0.01﹚。ODI由术前平均77.38%下降至术后6个月时的平均19.09%。根据MacNab标准，术后6个月时随访优10例（33.3%），良16例（53.3%），可3例（10%），差1例（3.3%），优良率86.6%。结论：经皮椎间孔内窥镜下椎间盘切除术治疗腰椎间盘突出症创伤小，并发症少，术后恢复快，近期疗效较满意。

英文摘要:

  【Abstract】 Objective：To evaluate the priliminary outcomes of percutaneous transforaminal endoscopic lumbar discectomy for lumbar disc herniation.Method：From September 2009 to March 2010，30 patients who had lumbar disc herniation and undergoing transforaminal microendoscopic discectomy were reviewed retrospectively.There were 19 males and 11 females，with an average age of 40.8 years.The mean follow-up was 9.2 months，and the mean course of disease was 9 months.All patients presented with back pain and sciatica of varied degrees，all had single level involved.The pathological type of disc herniation included lateral type in 25 and paramiddian type in 5.Surgery was performed under local anesthesia.The preoperative and postoperative visual analogue scale（VAS） were used to evaluate the leg pain and the back pain.The Oswestry disability index（ODI） and the MacNab scores at 6th months of the follow-up were also evaluated.Result：All cases underwent operation successfully.The operation time was 55-135min（mean，75min） and the blood loss was 5-30ml（average 12ml）.1 case with L5/S1 lumbar disc herniation was complicated with leg pain recurrence after relief.Another 1 case with L4/5 involvement presented with decreased knee reflexes.Both were relieved by drug intervention. All patients had VAS score of low back and leg pain decreased from preoperative 6.5 and 8.7 respectively to postoperative mean 1.9 and 1.5 respectively at 6th months of the follow-up（P＜0.01）.ODI decreased from preoperative 77.38% to postoperative mean 19.09%.According to Macnab criteria，the surgical outcomes were excellent in 10（33.3%） cases，good in 16（53.3%） cases，fair in 3（10%） cases with the excellent-to-good rate of 86.6%（P＜0.01）.Conclusion：Percutaneous transforaminal endoscopic lumbar discectomy for lumbar disc herniation is reliable and effective due to its minimal invasion，less complications and good prognosis.