【摘要】 [目的]介绍改良TESSYS技术治疗L₅S₁极外侧椎间盘突出症（extreme lateral intervertebral disc herniation, ELLDH）的技术要点及临床疗效。[方法]对32例L₅S₁ELLDH患者行此手术治疗。患者取俯卧位，透视定位并标记穿刺点，通常选择平L₅S₁间隙、后正中线旁开6～8 cm为穿刺点，以S₁上关节突外侧为着陆点，置入镜外环锯工作套管，必要时可切除L₅横突下部及骶骨翼部分骨质。在内镜视野下充分止血、清理周围软组织，显露S₁上关节突外侧骨质，使用镜外环锯或镜下磨钻去除部分S₁上关节突外侧骨质，显露L₅S₁椎间盘，进一步向头端及外侧显露L₅神经根，摘除突出髓核，松解神经根，最后用等离子射频手术电极对手术区域进行镜下彻底止血，纤维环破口予皱缩成形。[结果]32例患者均顺利完成手术，无严重并发症。与术前相比，术后6个月患者VAS评分[分,（6.1±0.9）,（0.9±0.8）, P<0.001]、ODI评分[%,（58.4±10.3）,（9.2±2.4）,P<0.001]和JOA评分[分,（10.6±1.7）,（24.3±1.1）, P<0.001]均显著改善；按照改良Macnab评价标准，优良率为90.6%（29/32）。影像方面，与术前相比，术后6个月患者受累L₅神经根分数各向异性值（fractional anisotropy, FA）[（0.276±0.029）,（0.357±0.032）, P<0.001]显著升高。[结论]改良TESSYS技术治疗L₅S₁极外侧突出症，安全有效，具有创伤小、减压效果确切等优点，临床疗效满意。更多还原

【Abstract】 [Objective] To introduce the surgical techniques and preliminary clinical outcome of the improved TESSYS technique for treating L₅S₁ extreme lateral intervertebral disc herniation（ELLDH）. [Methods] This technique was applied to 32 patients with L₅S₁ ELLDH.The patients were placed in the prone position, and the puncture site was marked under fluoroscopy. Usually, the L₅S₁ intervertebral space was selected, and the puncture point was set 6～8 cm lateral to the posterior midline. The lateral S₁ superior facet process was used as the landing point. An external trephine working cannula was inserted, and in necessary cases, the lower part of the L₅ transverse process and part of the sacral ala bone could be removed. Under the endoscopic field, adequate hemostasis was achieved, the surrounding soft tissues were removed to expose the lateral S₁ superior facet process, and part of the S₁ superior facet process was removed with the external tephine or bur.The L₅S₁ intervertebral disc was exposed, and the L₅ nerve root was further exposed cephalically and laterally. The protruded nucleus pulposus was removed, and the nerve root was released. Finally, the surgical area was thoroughly hemostatic under the endoscopic view by radiofrequency surgical electrode, and the annulus fibrosus rupture was trimmed. [Results] All 32 patients had operation performed successfully with no serious complications. Compared with those before the operation, the VAS score [points,（6.1±0.9）,（0.9±0.8）, P<0.001], ODI score[%,（58.4±10.3）,（9.2±2.4）, P<0.001], and JOA score [points,（10.6±1.7）,（24.3±1.1）, P<0.001] significantly improved 6 months after operation. According to the modified Macnab’s criteria, the excellent rate was of 90.6%（29/32）. Regarding imaging, compared with that preoperatively, the fractional anisotropy（FA） value of the affected L₅ nerve root significantly increased 6 months postoperatively [（0.276±0.029）,（0.357±0.032）, P<0.001]. [Conclusion] This modified TESSYS technique for treating L₅S₁ ELLDH is safe and effective, with advantages of small trauma and definite decompression effect, achieves satisfactory preliminary clinical consequece.更多还原