经椎间孔入路经皮内窥镜下腰椎椎间盘切除术治疗高位腰椎椎间盘突出症

摘要

Objective To investigate the clinical efficacy of percutaneous endoscopic transforaminal discectomy(PETD) in treatment of upper lumbar disc herniations.Methods From August 2010 to May 2014,the clinical data of 24 cases with upper lumbar disc herniations were retrospectively analyzed. The operation time,intraoperative blood loss,hospital stay,as wel as preoperative and postoperative 1 year low back and leg pain visual analogue scale(VAS)scores,the Oswestry disability index(ODI) were observed. Macnab criteria was used to evaluate the curative effect.Results Al cases were operated successfuly. The mean operation time was 74.6 min(ranged 60 -100 min),and the mean intraoperative blood loss was 24.0mL(ranged 15 -40 mL). The mean hospital stay was4.3d(ranged 3 -7 d) and the mean folow-up period was 21.1 months(ranged 14 -36 months). The low back pain VAS score was 6.88±1.33 at pre-operation,and it was1.96±0.91 at postoperative 1 year pre-operation, and the difference was statisticaly significant(P<0.01). The leg pain VAS score was 7.67±1.27 at pre-operation,and it was 1.83±0.76 at postoperative 1 year,and the difference was statistically significant(P<0.01). The ODI was(68.8±8.4)% at pre-operation, and it was(20.4±5.6)% at postoperative 1 year,and the difference was statisticaly significant(P<0.01). According to Macnab criteria,excelent in 16 cases,good in 5 cases,fair in 2 cases and poor in 1 case,and the excelent and good rate was 87.5%.Conclusion PETD could achieve satisfactory curative effect in upper lumbar disc herniations,which could be an effective method in treatment of upper lumbar disc herniations in practice.%目的：探讨经椎间孔入路经皮内窥镜下腰椎椎间盘切除术（PETD）治疗高位腰椎椎间盘突出症的临床疗效。方法回顾性分析2010年8月—2014年5月本院采用PETD治疗的24例高位腰椎椎间盘突出症患者临床资料。记录手术时间、术中出血量、住院天数，术前及术后12个月腰腿疼痛视觉模拟量表（VAS）评分及Oswestry功能障碍指数（ODI），采用Macnab标准评价临床疗效。结果所有患者手术顺利完成。手术时间60~100 min，平均74.6min；手术出血量15~40 mL，平均24.0mL；住院天数3~7 d，平均4.3 d；随访时间14~36个月，平均21.1个月。术前腰痛VAS评分为（6.88±1.33）分，术后12个月为（1.96±0.91）分，差异有统计学意义（P<0.01）；术前腿痛VAS评分为（7.67±1.27）分，术后12个月为（1.83±0.76）分，差异有统计学意义（P<0.01）。术前ODI值为（68.8±8.4）%，术后12个月为（20.4±5.6）%，差异有统计学意义（P<0.01）。根据Macnab标准，术后12个月随访时优16例、良5例、可2例，差1例，优良率为87.5%。结论 PETD治疗高位腰椎椎间盘突出症能够取得较为满意的疗效，是治疗高位腰椎椎间盘突出症的有效方法。