经皮椎间孔脊柱内窥镜治疗腰椎间盘突出症的疗效及安全性分析
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摘要
目的探讨经皮椎间孔脊柱内窥镜(transforaminal endoscopic spine system,TESSYS)治疗腰椎间盘突出症的疗效及安全性。方法回顾性分析2011年1月～2016年7月腰椎间盘突出症137例临床资料。均行TESSYS髓核摘除及神经根松解术,随访6个月。结果 137例均完成手术,手术时间(69. 7±14. 1) min。1例术后下肢疼痛无明显缓解,1周后行椎间孔镜下翻修术。术后6个月,日本骨科学会(Japanese Society of Orthopedics,JOA)下腰痛评分明显高于治疗前(24. 2±3. 9vs. 9. 3±2. 6,t=-37. 177,P=0. 000),Oswestry功能障碍指数(Oswestry disability index,ODI)显著下降[(14. 9±5. 6)%vs.(65. 4±11. 2)%,t=46. 667,P=0. 000],MacNab疗效评定,优98例,良32例,可6例,差1例,优良率94. 9%(130/137)。无严重并发症发生,随访期内未出现复发。结论 TESSYS技术治疗腰椎间盘突出症安全、有效。
Objective To explore the safety and efficiency of transforaminal endoscopic spine system( TESSYS) in the treatment of lumbar disc herniation. Methods A retrospective analysis was made on clinical data of 137 patients with lumbar disc herniation in our hospital from January 2011 to July 2016. All the patients underwent endoscopic nucleus pulposus excision and nerve root dissection by using the TESSYS and were followed up for 6 months. Results The operations were accomplished in all the 137 patients. The operation time was( 69. 7 ± 14. 1) min. One patient with lower limb pain symptoms was not significantly remitted after surgery and underwent a re-operation 1 week later. The Japanese Orthopedic Association( JOA) scores and Oswestry disability index( ODI) at 6 months after surgery were significantly better than those before the operation [( 24. 2 ± 3. 9) points vs.( 9. 3 ± 2. 6)points,t =-37. 177,P = 0. 000;( 14. 9 ± 5. 6) % vs.( 65. 4 ± 11. 2) %,t = 46. 667,P = 0. 000]. The MacNab criteria proved that there were 98 excellent cases,32 good cases,6 fair cases,and 1 poor case,with an excellent and good rate being 94. 9%( 130/137). The patients recovered in good condition,and no serious complications or recurrence were noted during follow-ups period.Conclusion The TESSYS treatment of lumbar disc herniation is an effective method for minimally invasive treatment of lumbar disc herniation.
Objective To explore the safety and efficiency of transforaminal endoscopic spine system( TESSYS) in the treatment of lumbar disc herniation. Methods A retrospective analysis was made on clinical data of 137 patients with lumbar disc herniation in our hospital from January 2011 to July 2016. All the patients underwent endoscopic nucleus pulposus excision and nerve root dissection by using the TESSYS and were followed up for 6 months. Results The operations were accomplished in all the 137 patients. The operation time was( 69. 7 ± 14. 1) min. One patient with lower limb pain symptoms was not significantly remitted after surgery and underwent a re-operation 1 week later. The Japanese Orthopedic Association( JOA) scores and Oswestry disability index( ODI) at 6 months after surgery were significantly better than those before the operation [( 24. 2 ± 3. 9) points vs.( 9. 3 ± 2. 6)points,t =-37. 177,P = 0. 000;( 14. 9 ± 5. 6) % vs.( 65. 4 ± 11. 2) %,t = 46. 667,P = 0. 000]. The MacNab criteria proved that there were 98 excellent cases,32 good cases,6 fair cases,and 1 poor case,with an excellent and good rate being 94. 9%( 130/137). The patients recovered in good condition,and no serious complications or recurrence were noted during follow-ups period.Conclusion The TESSYS treatment of lumbar disc herniation is an effective method for minimally invasive treatment of lumbar disc herniation.
引文
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2 李广松,乔荣慧,刘伟,等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄.中国微创外科杂志,2015,15(6):522-526.
3 蒋毅.微创内窥镜下经不同入路治疗重度脱出移位腰椎间盘突出症.中国骨伤,2017,30(2):100-104.
4 Altun I,Yuksei KZ. Histopathological analysis of ligamentum flavum in lumbar spinal stenosis and disc herniation. Asian Spine J,2017,11(1):71-74.
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6 Cano-rodrjgnez AI, Gonzalez-moga A. Clinical course of decompressive surgery for the treatment of lumbar stenosis. Acta Ortop Mex,2016,30(4):185-190.
7 罗凯,张学学,张达颖.脊柱内镜治疗腰椎间盘突出症不同手术入路的进展.中国疼痛医学杂志,2016,22(5):373-377.
8 Yadav YR,Parihar V,Kher Y,et al. Endoscopic inter laminar management of lumbar disease. Asian J Neurosurg,2016,11(1):1-7.
9 Nellensteijn J,Ostelo R,Bartels R,et al. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations:a systematic review of the literature. Eur Spine J,2010,19(2):181-204.
10 银和平,李树文,吴一民,等.显微内窥镜技术10年应用经验与思考.脊柱外科杂志,2012,10(1):3-6.
2 李广松,乔荣慧,刘伟,等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄.中国微创外科杂志,2015,15(6):522-526.
3 蒋毅.微创内窥镜下经不同入路治疗重度脱出移位腰椎间盘突出症.中国骨伤,2017,30(2):100-104.
4 Altun I,Yuksei KZ. Histopathological analysis of ligamentum flavum in lumbar spinal stenosis and disc herniation. Asian Spine J,2017,11(1):71-74.
5 Kim YU,Park JY,Kim DH,et al. The role of the ligamentum flavum area as a morphological parameter of lumbar central spinal stenosis.Pain Physician,2017,20(3):E419-E424.
6 Cano-rodrjgnez AI, Gonzalez-moga A. Clinical course of decompressive surgery for the treatment of lumbar stenosis. Acta Ortop Mex,2016,30(4):185-190.
7 罗凯,张学学,张达颖.脊柱内镜治疗腰椎间盘突出症不同手术入路的进展.中国疼痛医学杂志,2016,22(5):373-377.
8 Yadav YR,Parihar V,Kher Y,et al. Endoscopic inter laminar management of lumbar disease. Asian J Neurosurg,2016,11(1):1-7.
9 Nellensteijn J,Ostelo R,Bartels R,et al. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations:a systematic review of the literature. Eur Spine J,2010,19(2):181-204.
10 银和平,李树文,吴一民,等.显微内窥镜技术10年应用经验与思考.脊柱外科杂志,2012,10(1):3-6.