经椎间孔脊柱内窥镜系统治疗椎间盘源性腰痛

摘要

目的：探讨经椎间孔脊柱内窥镜系统（TESSYS）治疗椎间盘源性腰痛（DLBP）的疗效及其预后影响因素。方法回顾性分析2012年1月—2015年12月在本院脊柱外科就诊的慢性腰痛患者临床资料，按照入选标准，共58例DLBP患者入选，均接受TESSYS治疗。患者手术前后的腰痛情况和腰椎功能用疼痛视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评估，评估末次随访时疗效用改良MacNab标准。结果所有患者随访6~48个月，平均24.5个月。患者术前腰痛VAS评分为（6.8±2.3）分，术后即刻为（3.5±1.4）分，末次随访为（1.2±0.9）分，各时间点间差异均有统计学意义（P<0.05）；术前ODI为（33.7±3.6）%，术后即刻为（18.6±2.9）%，末次随访为（9.3±1.8）%，各时间点间差异均有统计学意义（P<0.05）。52例患者术中可见散在炎性病灶，其中22例仅有纤维环破口处炎性灶，另30例尚有硬膜囊腹侧、后纵韧带表面散在炎症灶，且对炎性病灶刺激后可以复制疼痛。此52例患者末次随访时临床疗效优良率为78.8%，显著高于余6例患者的33.3%，差异有统计学意义（P<0.05）。结论 TESSYS是治疗DLBP的有效手段，术中对纤维环破口处、椎管内后纵韧带和硬膜囊等椎间盘外组织上的炎性病灶的热凝处理，可以提高疗效。%Objective To observe the clinical efficacy of transforaminal endoscopic spine system(TESSYS) for the treatment of discogenic low back pain(DLBP). Methods A total of 58 DLBP patients meeting the inclusion criteria from January 2012 to December 2015 were involved in this retrospective research. The efficacy of TESSYS was assessed by visual analogue scale(VAS) score for low back pain,and the Oswestry disability index(ODI) for functional recovery. The modified MacNab criteria was used to assess the surgical results at the final follow-up. Results The follow-up time was 24.5±9.8 months,ranged 6-48 months. VAS score was 6.8±2.3 at pre-operation,3.5±1.4 immediately post-operation,and 1.2±0.9 at the final follow-up;the difference was statistically significant at all time points(P<0.05). ODI was (33.7±3.6)%at pre-operation,(18.6±2.9)%at immediately post-operation,and (9.3±1.8)%at the final follow-up;the difference was statistically significant at all time points(P<0.05). Sporaic inflammation lesions were observed in 52 patients,inflammation on annulus fibrosus rent in 22 and on the ventral side of the dural sac and the surface of the posterior longitudinal ligamentin addition to the annulus fibrosus rent in 30. The pain could be replicated after stimulation to the inflammatory lesion. The effectiveness rate was 78.8%at the final follow-up in the 52 patients, which was significantly higher than that in the other 6 patients(P<0.05). Conclusion TESSYS is an effective means for treating DLBP. Heat coagulation management of inflammatory lesions on the annulus fibrosus,posterior longitudinal ligament or dura sac can enhance the therapeutic efficacy of TESSYS.