经皮椎间孔内窥镜下腰椎间盘切除术治疗腰椎间盘突出症的初期疗效

摘要

目的：评价经皮椎间孔内窥镜下腰椎间盘切除术治疗腰椎间盘突出症的初期疗效。方法2013年12月至2014年5月采用 TESSYS 技术行经皮椎间孔内窥镜下腰椎间盘切除术，治疗腰椎间盘突出症患者117例。记录患者术前、术后不同时间点的腰腿痛 VAS 评分；记录术前、术后患者的 Oswestry 功能障碍指数（ODI），评价腰椎功能情况；根据 MacNab 疗效评价标准，记录术后3月疗效结果。结果117例手术均顺利完成，术后当日即可佩戴腰围下床活动。患者腰痛、下肢痛 VAS评分由术前的6.98、8.19分下降至术后1 d 3.21、2.83分，术后1月2.06、2.45分，术后3月1.64、1.92分，术后各时间点VAS 评分与术前相比均有显著性差异（P ＜0.01）。 ODI 由术前的75．93％降至术后3月时21.46％。术后3月随访，按照MacNab 评价标准，优者51例（43.59％），良者59例（50.43％），可者7例（5.98％），差者0例，有效率100％，优良率94.02％。结论采用 TESSYS 技术行经皮椎间孔内窥镜下腰椎间盘切除术治疗腰椎间盘突出症效果显著，具有创伤小、卧床时间短、并发症少、术后恢复快等优点。%Objective To evaluate the primary clinical outcome of percutaneous transforaminal endoscopic lumbar discectomy for lumbar disc herniation .Methods 117 patients who were confirmed lubmar disc herniation were treated with percutaneous transforaminal endoscopic lumbar discectomy by TESSYS technique from December 2013 to May 2014 .The preoperative and postoperative visual analogue scale(VAS) for low back pain and sciatica at different time points were compared .The Oswestry disability index(ODI) was evaluated to judge the lumbar function .The MacNab criteria was employed to grade the clinical out‐come at 3rd month after operation .Results 117 cases of operation were all completed successfully .The mean VAS score of low back and sciatica decreased from preoperative 6.98 and 8.19 respectively to postoperative 3.21 and 2.83 at 1‐day follow‐up , 2.06 and 2.45 at 1‐month follow‐up ,1.64 and 1.92 at 3‐month follow‐up(P< 0.01) .ODI improved from preoperative 75.93%to 21.46% at 3‐month follow‐up .According to the Macnab criteria ,there were excellent outcomes in 51 patients (43.59% ) , good outcomes in 59 patients(50.43% ) fair outcomes in 7 patients (5.98% ) and no poor outcome at the last follow‐up .And the excellent‐to‐good rate was 94.02% .Conclusion Percutaneous transforaminal endoscopic lumbar discectomy by TESSYS technique provides an effective way to treat lumbar disc herniation due to its high percentage of patient satisfaction ,which has many advantages such as little trauma ,brief hospitalization ,fewer complications ,faster post‐surgical rehabilitation .