经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症疗效及2年随访分析
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摘要
目的:探讨经皮椎间孔镜(TESSYS)技术治疗腰椎间盘突出症(LDH)的临床疗效及2年随访分析。方法:选择某院单节段腰椎间盘突出的手术患者124例,其中使用TESSYS技术治疗的68例(观察组),使用黄韧带扩大开窗术手术治疗56例(对照组),统计分析术前、术后即刻与术后2年随访的ODI,VAS指数和Macnab评分的变化,同时比较2组患者围手术期相关指标与随访并发症发生率及复发率,评价TESSYS手术与黄韧带扩大开窗术在腰椎间盘突出治疗的疗效差异。结果:2组患者术后与2年随访的ODI评分、VAS评分以及Macnab评分比较,差异无统计学意义(P> 0. 05); 2组患者术后并发症发生率以及复发率比较,差异无统计学意义(P> 0. 05); 2组患者手术时间、术中出血量以及住院日比较,观察组优于对照组,差异有统计学意义(P <0. 05)。结论:TESSYS技术可以有效的治疗腰椎间盘突出症患者,极大程度的缓解患者的相关症状,同时可以减少术中出血量,缩短手术及住院时间。随访结果显示,使用TESSYS技术治疗LDH不会增加并发症与椎间盘突出的复发率。
Objective: To explore the efficacy of transforaminal endoscopic surgical system( TESSYS) technique in the treatment of lumbar disc herniation( LDH) and analyze a two-year follow-up. Methods: 124 patients with single-level LDH were selected. 68 of them were treated with TESSYS and another 56 underwent enlarged fenestration of ligamentum flavum. The changes of ODI,VAS index and Macnab score were statistically analyzed before operation,immediately after operation and two years after operation. The effect of TESSYS on LDH was evaluated and compared with enlarged fenestration of ligamentum flavum. Results: There was no significant difference in ODI score,VAS score and Macnab score between the two groups( P > 0. 05). There was no significant difference in the incidence of postoperative complications and recurrence probability between the two groups( P > 0. 05). The observation group was significantly better than the control group in terms of the operation time,intraoperative bleeding volume and hospitalization( P < 0. 05). Conclusion: TESSYS can effectively treat lumbar intervertebral disc herniation and greatly alleviate the related symptoms. It can shorten the operation time and hospital stay and reduce intraoperative bleeding. The follow-up study indicates that TESSYS does not increase the risk of complications and recurrence of LDH.
Objective: To explore the efficacy of transforaminal endoscopic surgical system( TESSYS) technique in the treatment of lumbar disc herniation( LDH) and analyze a two-year follow-up. Methods: 124 patients with single-level LDH were selected. 68 of them were treated with TESSYS and another 56 underwent enlarged fenestration of ligamentum flavum. The changes of ODI,VAS index and Macnab score were statistically analyzed before operation,immediately after operation and two years after operation. The effect of TESSYS on LDH was evaluated and compared with enlarged fenestration of ligamentum flavum. Results: There was no significant difference in ODI score,VAS score and Macnab score between the two groups( P > 0. 05). There was no significant difference in the incidence of postoperative complications and recurrence probability between the two groups( P > 0. 05). The observation group was significantly better than the control group in terms of the operation time,intraoperative bleeding volume and hospitalization( P < 0. 05). Conclusion: TESSYS can effectively treat lumbar intervertebral disc herniation and greatly alleviate the related symptoms. It can shorten the operation time and hospital stay and reduce intraoperative bleeding. The follow-up study indicates that TESSYS does not increase the risk of complications and recurrence of LDH.
引文
[1]黄先育,赵金亮. TESSYS技术治疗单纯腰椎间盘突出的疗效及并发症[J].临床骨科杂志,2018(4):440-443.
[2]周跃,李长青,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
[3] HE S,SUN Z,WANG Y,et al. Combining YESS and TESSYS techniques during percutaneous transforaminal endoscopic discectomy for multilevel lumbar disc herniation[J]. Medicine(Baltimore),2018,97(28):e11240.
[4] XIONG C,LI T,KANG H,et al. Early outcomes of 270-degree spinal canal decompression by using TESSYS-ISEE technique in patients with lumbar spinal stenosis combined with disk herniation[J]. Eur Spine J,2018.
[5] PAN Z,HA Y,YI S,et al. Efficacy of Transforaminal Endoscopic Spine System(TESSYS)Technique in Treating Lumbar Disc Herniation[J]. Med Sci Monit,2016,22:530-539.
[6]吴健,范胜利,关月红.经椎间孔脊柱内窥镜系统髓核摘除术治疗腰椎椎间盘突出症短期临床疗效及操作技巧分析[J].脊柱外科杂志,2017,15(5):304-307.
[7] RUIZ F K,BOHL DD,WEBB ML,et al. Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale[J]. The Spine Journal,2014,14(9):1860-1865.
[8] BEHREND CJ,SCHNBACH EM,VACCARO AR,et al. Maximum pain on visual analog scales in spinal disorders[J]. The Spine Journal,2017,17(8):1061-1065.
[9] BURKE SM,SAFAIN MG,KRYZANSKI J,et al. Nerve root anomalies:implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system[J]. Neurosurg Focus,2013,35(2):E9.
[10] XIN G,SHI-SHENG H,HAI-LONG Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy[J]. Clin Anat,2013,26(6):728-734.
[11]吴冠男,张世民,靳蛟,等.经皮椎间孔镜技术治疗腰椎间盘突出症[J].中国骨伤,2017,30(9):861-865.
[12]聂治军,张文芳,张银刚,等.经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出的近期疗效观察[J].临床骨科杂志,2018,21(2):153-156.
[13]丁允知,胡敬男,周勇.经皮椎间孔镜下行TESSYS技术与椎间盘镜下手术治疗腰椎间盘突出症的效果对比[J].颈腰痛杂志,2017,38(5):492-493.
[14]华凤伟.经皮椎间孔镜下行TESSYS技术治疗老年腰椎间盘突出的临床效果分析[J].中国医疗器械信息,2018,24(12):19-20.
[2]周跃,李长青,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
[3] HE S,SUN Z,WANG Y,et al. Combining YESS and TESSYS techniques during percutaneous transforaminal endoscopic discectomy for multilevel lumbar disc herniation[J]. Medicine(Baltimore),2018,97(28):e11240.
[4] XIONG C,LI T,KANG H,et al. Early outcomes of 270-degree spinal canal decompression by using TESSYS-ISEE technique in patients with lumbar spinal stenosis combined with disk herniation[J]. Eur Spine J,2018.
[5] PAN Z,HA Y,YI S,et al. Efficacy of Transforaminal Endoscopic Spine System(TESSYS)Technique in Treating Lumbar Disc Herniation[J]. Med Sci Monit,2016,22:530-539.
[6]吴健,范胜利,关月红.经椎间孔脊柱内窥镜系统髓核摘除术治疗腰椎椎间盘突出症短期临床疗效及操作技巧分析[J].脊柱外科杂志,2017,15(5):304-307.
[7] RUIZ F K,BOHL DD,WEBB ML,et al. Oswestry Disability Index is a better indicator of lumbar motion than the Visual Analogue Scale[J]. The Spine Journal,2014,14(9):1860-1865.
[8] BEHREND CJ,SCHNBACH EM,VACCARO AR,et al. Maximum pain on visual analog scales in spinal disorders[J]. The Spine Journal,2017,17(8):1061-1065.
[9] BURKE SM,SAFAIN MG,KRYZANSKI J,et al. Nerve root anomalies:implications for transforaminal lumbar interbody fusion surgery and a review of the Neidre and Macnab classification system[J]. Neurosurg Focus,2013,35(2):E9.
[10] XIN G,SHI-SHENG H,HAI-LONG Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy[J]. Clin Anat,2013,26(6):728-734.
[11]吴冠男,张世民,靳蛟,等.经皮椎间孔镜技术治疗腰椎间盘突出症[J].中国骨伤,2017,30(9):861-865.
[12]聂治军,张文芳,张银刚,等.经皮椎间孔镜下TESSYS技术治疗腰椎间盘突出的近期疗效观察[J].临床骨科杂志,2018,21(2):153-156.
[13]丁允知,胡敬男,周勇.经皮椎间孔镜下行TESSYS技术与椎间盘镜下手术治疗腰椎间盘突出症的效果对比[J].颈腰痛杂志,2017,38(5):492-493.
[14]华凤伟.经皮椎间孔镜下行TESSYS技术治疗老年腰椎间盘突出的临床效果分析[J].中国医疗器械信息,2018,24(12):19-20.