经椎间孔脊柱内窥镜技术治疗腰腿痛的适应证
Indications of transforaminal endoscopic spine system for treatment of low back and leg pain
杨维权 1孙荣华 1李德粦 1植致敏 1蒋冬东 1张贺飞 1姚力熙 1刘大雄1
作者信息
- 1. 解放军第85医院骨科,上海200052
- 折叠
摘要
[目的]探讨腰腿痛患者选择经椎间孔脊柱内窥镜技术(transforaminal endoscopic spine system,TESSYS)治疗的适应证及临床疗效.[方法]回顾性分析2013年12月～ 2015年6月本院采用TESSYS技术治疗的512例腰腿痛患者,其中腰椎间盘突出症441例、腰椎管狭窄症48例,腰椎滑脱(Ⅰ度)23例.年龄18 ～ 85岁,平均56.6岁,采用疼痛视觉模拟评分(VAS)及改良Macnab疗效评定标准评价临床疗效.[结果]手术时间45～180 min,平均60.8 min;C型臂X线机曝光频率13 ～62次,平均17.8次.术中硬膜囊撕裂12例,头颈部疼痛4例,2例术后出现肌力一过性下降,无神经根损伤、椎间隙感染等严重并发症.468例(91.4％)术后随访时间3 ～15个月,平均10.5个月.改良Macnab疗效评定:优398例,良40例,可17例,差13例,优良率93.6％.术前VAS评分(8.7±1.4)分,术后即刻(2.6±1.6)、术后3个月(1.8±0.6)、末次随访时(1.9±1.3).[结论] TESSYS是治疗腰腿痛的一种安全有效的微创技术,正确放置工作通道是扩大手术适应证的关键.
Abstract
[Objective] To investigate the indications and clinical outcomes of transforaminal endoscopic spine system (TESSYS) in the treatment of low back and leg pain.[Methods] A retrospective analysis was performed on the clinical data of 512 patients,who complained of low back and leg pain and were treated using the TESSYS technique in our hospital from December 2013 to June 2015.Of the 512 cases,411 had lumbar disc herniation,48 had lumbar spinal stenosis,and 23 had lumbar spondylolisthesis (Ⅰ°).Their mean age was 56.6 years (18 ～ 85 years).The clinical outcome was evaluated using the Visual Analogue Scale (VAS) and modified Macnab criteria [Results] The mean operation time was 60.8 min (45 ～ 180 min),and the mean frequency of exposure to C-arm machine was 17.8 times (13 ～ 62 times).During operation,dural tear occurred in 12 cases,and head and neck pain occurred in 4 cases.After surgery,transient decrease in muscle strength occurred in 2 cases.No patient had severe complications,such as nerve root injury and intervertebral discitis.A total of 468 patients (91.4％) were followed up for 10.5 months (3 ～ 15 months).According to the modified Macnab criteria,the outcome was excellent in 398 cases,good in 40 cases,fair in 17 cases,and poor in 13 cases;the overall excellent and good outcomes rate was 93.6％.The preoperative VAS score was (8.7 ± 1.4),and the VAS score was (2.6 ± 1.6) immediately after surgery,(1.8 ± 0.6) at 3 months after surgery,and (1.9 ± 1.3) at the last follow-up.[Conclusion] As a minimally invasive technique,TESSYS is safe and effective for the treatment of low back and leg pain.The appropriate position of working channel is the key to expanding the surgical indications.
关键词
经椎间孔脊柱内窥镜技术/腰椎间盘突出症/腰椎管狭窄症/腰椎滑脱/微创技术Key words
transforaminal endoscopic spine system/lumbar disc herniation/lumbar spinal stenosis/lumbar spondylolisthesis/minimally invasive technique引用本文复制引用
出版年
2016
NETL
NSTL
维普
万方数据