Objective To investigate the clinical outcome and experience of percutaneous endoscopic discectomy in the early stage.Methods The first 100 patients who underwent percutaneous endoscopic discectomy via transforaminal approach in our hospital from Jan 2013 to May 2014 were retrospectively studied.There were 59 males and 41 females with mean age of (33.2±6.1) years (range from 18 to 63 years).There were 23 cases with middle lumbar disc herniation,60 cases with lateral lumbar disc herniation,5 cases with far lateral lumbar disc herniation,7 cases with caudal migrated lumbar disc herniation and 5 cases with calcified lumbar disc herniation.With regard to index level,there were 5 cases at the L3/4,60 cases at the L4/5,31 cases at the L5/S1,4 cases at the L4/5 and L5/S1,and 1 case at the L3/4 and L4/5.The learning curves were evaluated by puncturing time,endoscopic operating time,and fluoroscopy times.Clinical outcome were evaluated by Japanese Orthopedic Association (JOA) scores and Visual Analogue Scale (VAS) preoperatively,at 1 day,3 months and 12 months postoperatively.The complications were also recorded.Results The mean follow-up period was 12.3 months (range from 9 to 15 months).The mean puncturing time was (28.4±11.7) minutes (range from 15 to 100 minutes) and the mean endoscopic operating time was (38.6±12.2) minutes (range from 15 to 90 minutes).The mean fluoroscopy times were (9.1±3.1) (range from 4 to 51).The JOA score increased from preoperative mean (10.5±3.1) to mean (25.2±3.3) at 12 months postoperatively.The VAS score decreased from preoperative mean (8.3±2.1) to mean (1.7±0.5) at 12 months postoperatively.2 cases had dural tear,1 case suffered from recurrent lumbar disc herniation.1 case demonstrated intervertebral metallic artifacts on MRI scans at 1 week postoperatively,but no metallic debris was detected on the CT scans and the patient was asymptomatic during the follow-up periods.Conclusion Percutaneous endoscopic discectomy has a steep leaming curve.Clinical outcome on the early stage was satisfactory.%目的 研究椎间孔镜下髓核摘除术的早期临床疗效及治疗经验.方法 回顾性分析2013年1月～2014年5月于我科行经皮穿刺椎间孔镜下髓核摘除术的前100例患者.患者均为经椎间孔入路,其中男59例,女41例,平均年龄(33.2±6.1)岁(18～63岁).中央型突出23例,旁侧型突出60例,极外侧型突出5例,脱出下移患者7例,突出伴钙化5例.L3/45例,L4//560例,L5/S1 31例,L4/5和L5S1双节段3例,L3/4和L4/5双节段1例.术前所有患者行腰椎正侧位片、腰椎过伸过屈位片、腰椎CT、腰椎MRI检查.记录穿刺时间、透视次数、镜下操作时间来研究学习曲线.记录患者术前、术后1天,术后3月及术后12月日本骨科学会评分(JOA)和视觉疼痛评分(VAS),评估临床疗效并记录术中术后相关并发症.结果 所有患者平均随访12.3月(9～15月),平均穿刺时间为(28.4±11.7)分钟(15～100分钟),平均镜下操作时间为(38.6±12.2)分钟(15～90分钟).平均透视次数为(9.1±3.1)次(4～51)次.JOA评分术前平均为(10.5±3.1),术后12月平均为(25.2±3.3);VAS评分术前平均为(8.3±2.1),术后12个月平均为(1.7±0.5).2例患者术中出现硬脊膜损伤,1例患者术后复发,1例患者术后MRI检查椎间隙内见金属伪影,CT检查未见异常,随访1年无不适.结论 经皮穿刺椎间孔镜下髓核摘除术早期可以取得良好的治疗效果,并发症较少,该项技术有陡峭的学习曲线,需在实践中逐渐掌握熟练的穿刺及镜下操作技术.
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