经皮椎间孔镜靶向穿刺技术治疗腰椎椎间盘突出症的疗效分析

摘要

目的 探讨靶向穿刺经皮椎间孔镜下腰椎椎间盘切除术治疗腰椎椎间盘突出症的安全性和有效性.方法 2011年5月～2012年2月58例单节段腰椎椎间盘突出症患者,局麻后影像学监视下行靶向穿刺,经皮椎间孔镜下行髓核摘除、直接减压手术.采用视觉模拟量表(visual analog scale,VAS)评分、0swestry功能障碍指数(Oswestrydisability index,ODI)和MacNab标准评估手术疗效.结果 患者术后平均随访18.5个月,术后各时间点腰腿痛VAS评分较术前均明显降低(P＜0.01)；术后12个月,ODI由术前平均72.4％降至平均19.7％ (P ＜0.01),按MacNab标准评定疗效优良率93.1％.结论 经皮椎间孔镜靶向穿刺技术治疗腰椎椎间盘突出症创伤小,并发症少,术后恢复快,近期疗效可靠,靶向穿刺是手术成功的首要前提和重要步骤.%Objective To evaluate the security and effectiveness of targeted percutaneous transforaminal endoscopic discectomy(PTED) in treating lumbar disc herniation.Methods A total of 58 patients with single segment lumbar disc herniation who were treated with PTED from May 2011 to February 2012 were retrospectively analyzed.All patients underwent targeted paracentesis and PTED after local anesthesia.The clinical outcomes were evaluated by visual analog scale (VAS) scores,Oswestry disability index(ODI) and modified Macnab criteria pre-and postoperative or at the final follow-up.Results All patientswere followed up for 12-22 months (mean 18.5 months).Compared with the preoperative VAS scores,the postoperative scores of back and leg pain were significantly decreased,and the difference was statistically significant (P ＜0.01).ODI before and 12 months after operation were 72.4％ and 19.7％ respectively.There were significant differences compared with preoperative score (P ＜0.01).According to the modified Macnab criteria,the excellent and good rate was 93.1％.Conclusion Targeted PTED is safe and effective in the treatment of lumbar disc herniation,which has little trauma and few complications.Meanwhile,targeted puncture is the significant premise and key process to perform a successful operation.