经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症

Minimally invasive targeted percutaneous endoscopic lumbar discectomy for lumbar disc herniation

中文关键词:  腰椎间盘突出症  经皮椎间孔内窥镜  靶向穿刺  椎间盘切除术

英文关键词:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Minimally invasive spine surgery  Targeted surgery

中文摘要:

  【摘要】 目的：探讨经皮椎间孔内窥镜下靶向穿刺椎间盘切除术治疗腰椎间盘突出症的安全性及有效性。方法：选择2009年10月~2012年3月收治的237例单节段腰椎间盘突出症患者，男144例，女93例；平均年龄44.8岁，均存在明显腰腿痛，并经CT及MRI检查证实为单节段腰椎间盘突出。在局麻及影像学监视下行靶向穿刺，逐级扩张软组织，切除部分上关节突腹侧缘，安放工作通道，经皮椎间孔内窥镜下完成髓核摘除术。采用视觉模拟评分法（VAS评分）、Oswestry功能障碍指数（ODI）、MacNab评分等评定疗效。结果：平均手术时间53min，平均出血量20ml，无1例手术并发症发生，术后3h即可在硬腰围保护下下床活动。212例随访12～24个月，平均15.5个月，术前VAS评分为7.8±3.6分，术后12个月为1.8±1.1分，手术前后有显著性差异（P＜0.01）；术前ODI为（53.2±13.5）%，术后12个月为（17.3±6.4）%，手术前后有显著性差异（P＜0.01）；术后12个月MacNab评分优167例，良36例，中9例，优良率为95.8%。5例患者术后7~20个月复发，复发率为2.4%，均行后路内窥镜下椎间盘切除翻修术后恢复。结论：经皮椎间孔内窥镜下靶向穿刺椎间盘切除术是治疗腰椎间盘突出症安全、有效的微创手段。

英文摘要:

  【Abstract】 Objectives: To determine the safety and efficacy of minimally invasive targeted percutaneous endoscopic lumbar discectomy(PELD) for lumbar disc herniation. Methods: A retrospective review was performed on 237 patients(144 males and 93 females) with lumbar disc herniation between October 2009 and March 2012. The average age was 44.8 years old. All patients presented with typical low back pain and sciatica, and were confirmed as single level lumbar disc herniation by CT and MRI. After local anesthesia, percutaneous targeted puncture was placed through a 18G long needle assisted by C-arm monitoring. Then, the guiding wire was placed through the needle, the series of tubes expanded the soft tissue over the wire, the part of the facet was removed by reamers, the working tube was placed on the herniated disc, finally PELD was performed assisted by TESSYSTM system. The pain and daily activity was evaluated by the visual analog score(VAS) and the Oswestry disability index(ODI) respectively. Modified MacNab criteria were employed to measure the clinical results. Results: The mean operation time was 53min, the mean blood loss was 20ml， no complication was noted. The patients were permitted to move wearing hard waist 3 hours after operation. The mean follow-up period was 15.5 months(range，12-24 months) in 212 patients. The mean VAS improved from 7.8±3.6 at preoperation to 1.8±1.1 at last follow-up. The mean ODI was improved from (53.2±13.5)% to (17.3±6.4)%. After 12 months after operation, 95.8% of patients showed excellent(167 patients) or good(36 patients) outcomes according to the modified MacNab criteria. 5 patients(2.4%) suffered from recurrent herniation after 7-20 months, and another microendoscopic discectomy(MED) was performed. Conclusions: Minimally invasive targeted percutaneous endoscopic lumbar discectomy is safe and effective for lumbar disc herniation.