摘要：

目的 探讨经椎板间入路椎间孔镜技术治疗腰椎间盘突出症的临床疗效。方法 采用经椎板间入路椎间孔镜TESSYS 技术治疗54 例腰椎间盘突出症患者（L_4-5 椎间盘突出13 例、L₅-S₁ 椎间盘突出41 例），分别于术前和术后1 d、3 个月、1 年时采用视觉模拟评分（VAS）和Oswestry 功能障碍指数（ODI）评价手术前后疼痛改善情况，复查腰椎MRI 评价髓核摘除情况和有无复发。结果 54 例患者手术成功率为96.30%（52/54），其中2 例术中出现硬脊膜破裂，改为手术显微镜下椎板开窗、髓核摘除术。平均手术时间58.35 min，中位住院时间3 d。出院时52 例疼痛消失、2 例疼痛减轻，其中5 例患侧小腿外侧麻木感加重。与术前相比，术后1 d、3 个月和1 年时VAS 和ODI 评分均减少（均P = 0.000）。术后复查腰椎MRI 显示髓核摘除满意，神经根压迫解除，亦未见复发。无一例发生感染等手术相关并发症，1 例L₅-S₁ 椎间盘突出患者因髓核脱出椎管内游离较远，术中对神经根牵拉较重，术后出现S1 神经根分布区麻木，术后1 个月缓解。结论 经椎板间入路椎间孔镜技术治疗腰椎间盘突出症临床疗效满意、安全性良好。

关键词: 椎间盘移位, 腰椎, 椎间盘切除术, 经皮, 内窥镜检查, 外科手术, 微创性

Abstract:

Objective  To evaluate the therapeutic efficacy of percutaneous transforaminal endoscopic discectomy (PTED) through interlaminar approach in the treatment of lumbar disc herniation (LDH).  Methods  From October 2013 to January 2015, 54 LDH patients underwent PTED by using transforaminal endoscopic spine system (TESSYS) in our hospitial. CT or MRI indicated L_4-5 disc herniation in 13 patients and L₅-S₁ disc herniation in other 41 patients. Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the degree of pain in the low back and leg before operation, one day, 3 months and one year after operation. MRI was performed after operation to assess if the nucleus pulposus was removed completely and whether there was a relapse.  Results  The success rate of operations was 96.30% (52/54). Two patients suffered from rupture of spinal dura mater during the surgery, and underwent fenestration laminectomy in turn. The average operation time was 58.35 min and median hospital stay was 3 d. At discharge, pain was disappeared in 52 patients and relieved in 2 patients, however, 5 patients presented worsened numbness of lateral lower leg. Compared with preoperation, VAS and ODI scores decreased significantly one day, 3 months and one year after operation (P = 0.000, for all). Lumbar MRI one day after operation revealed nucleus pulposus had been completely removed and the compression of nerve root had been relieved in all cases. There was no relapse in MRI findings 3 months and one year after operation. No surgical complication, such as infection, was found. One patient with L₅-S₁ disc herniation presented postoperative numbness of S₁ nerve root region caused by heavy stretching of nerve root during the operation, and was improved one month later.  Conclusions  Percutaneous transforaminal endoscopic discectomy through interlaminar approach in the treatment of lumbar disc herniation is effective and safe.

Key words: Intervertebral disk displacement, Lumbar vertebrae, Diskectomy, percutaneous, Endoscopy, Surgical procedures, minimally invasive