【摘要】 [目的]探讨侧路椎间孔镜腰椎间盘切除术后6年以上中期疗效。[方法]回顾性分析2012年1月～2013年6月通过侧路椎间孔镜腰椎间盘切除术后随访6年以上的42例患者。男24例,女18例,平均年龄(48.56±6.34)岁,腰椎间盘突出症37例,腰椎管狭窄症5例。均行俯卧位单节段椎间孔镜下腰椎间盘切除手术治疗。观察术前、术后6个月和末次随访直腿抬高试验角度、腰痛VAS评分、腿痛VAS评分、JOA评分、Oswestry功能障碍指数(ODI)和McNab优良率;影像观察手术节段椎间隙高度和节段稳定性。[结果]本组病例均顺利手术,术中无硬膜撕裂、神经根损伤发生,术后无感染发生。随访75～93个月,平均(82.75±5.52)个月。2例患者(4.76%)接受了翻修术,均在术后3个月内;1例YESS患者因腿痛缓解不满意,行同节段椎间孔镜TESSYS翻修;另1例患者因复发并腰痛行手术节段及下位节段腰椎融合术。与术前相比,术后6个月和末次随访时,42例患者直腿抬高试验角度显著增加(P<0.05),腰痛和腿痛VAS评分均显著减少(P<0.05),腰椎JOA评分显著提高(P<0.05),ODI评分显著减少(P<0.05)。按McNab标准,临床优良率术后6个月为83.33%,末次随访时为85.71%。影像方面,末次随访时手术节段椎间隙高度为术前的(84.52±5.66)%,动力位影像未见腰椎不稳征象。[结论]侧路椎间孔镜腰椎间盘切除术后不仅术后6个月时的近期疗效良好,6年以上随访的中期疗效亦保持良好。术后6年以上虽有椎间隙高度轻度下降,但无手术节段失稳征象。更多还原

【Abstract】 [Objective] To investigate the mid-term clinical outcomes of percutaneous endoscopic lumbar discectomy(PELD). [Methods] A retrospective study was conducted on42 patients who underwent PELD from January 2012 to June2013 in our department and followed up more than 6 years,including 24 males and 18 females aged(48.56±6.34) on average. Of them, 37 patients suffered from lumbar disc herniation and 5 came down with lumbar canal stenosis. All the patients had single-segment PELD performed through lateral approach in prone position. The angle of straight leg raise, visual analogue scale for low back pain and leg pain, Japanese Orthopaedic Association score for lumbar spine, Oswestry disability index and clinical consequences graded by McNab’s criteria were evaluated before operation, at 6 months postoperatively and the latest follow. In addition, radiographic examinations were done to assess the height and stability of affected intervertebral space. [Results] All the patients had PELD performed successfully,without complications, such as dural tear, never root injuries and incision infection. The follow up period lasted for 75～93 months with an average of(82.75±5.52) months. Two patients(4.76%) had revision surgery in 3 months after primary operation,including one case of secondary PELD with TESSYS technique at the same segment due to unsatisfaction to primary PELD with YESS technique, and one case of instrumented fusion of the lower adjacent segment due to severe recurrent pain. Compared the data before operation the angle of straight leg raise and the JOA score significantly increased(P<0.05), whereas the VAS and ODI scores significantly decreased at 6 months postoperatively and the latest follow up(P<0.05). According to McNab’s criteria, the excellent and good rate of clinical outcomes was of 83.33% at 6 months after operation, while became 85.71% at the latest follow up, which was not statistically significant(P>0.05). With respect to radiographic assessment, the involved intervertebral space height at the latest follow up decreased to(84.52±5.66) % of that before operation, but no sign of the segment instability on dynamic X-ray films was found in any patient. [Conclusion] This PELD through lateral approach not only achieve satisfactory clinical outcomes at 6 months postoperatively, but also keep pleasurable results more than 6 years after operation. Regardless of mild loss of intervertebral space height, no instability phenomenon of the affected space appears on images.更多还原