Effect of percutaneous transforaminal endoscopic discectomy in treating prolapsed lumbar disc herniation
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摘要:目的 观察经皮椎间孔镜髓核摘除术（PTED）治疗66例脱出型腰椎间盘突出症（LDH）的效果，并探讨预后影响因素。方法 回顾性分析66例采用PTED治疗脱出型LDH患者的临床资料，所有患者均行腰椎动力位片和核磁共振检查。记录术前及术后视觉模拟评分法（VAS）评分，卡氏功能状态评分标准（KPS）评分及日本矫形外科学会（JOA）腰痛评分，术后随访期间记录症状缓解、复发及并发症发生情况。结果 术后，患者VAS评分低于术前，KPS及JOA评分高于术前，差异均有统计学意义（P < 0.05）。术后并发症的发生与椎间盘突出程度相关（P < 0.05）；复发型LDH患者术后更易复发（P < 0.05）。结论 PTED手术时间短，术中出血量及术后并发症较少，是治疗脱出型LDH的安全、有效方法。重度LDH患者应更加注意预防术后并发症的发生，复发型LDH患者在选择PTED治疗时应注意把握适应证。Abstract:Objective To observe clinical effect of percutaneous transforaminal endoscopic discectomy (PTED) in treating patients with prolapsed lumbar disc herniation (LDH), and to explore influencing factors of prognosis.Methods The clinical data of 66 cases diagnosed as prolapsed LDH was retrospectively analyzed, and all of the patients underwent lumbar flexion-extension radiographs and magnetic resonance imaging. The preoperative and postoperative Visual Analogue Scale (VAS) scores, Karnofsky performance scale (KPS) score and Japanese Orthopedic Association (JOA) score for lumber pain were recorded, the conditions of symptom relief, recurrence and other complications were recorded.Results After surgery, VAS score was significantly lower than that before surgery, and KPS and JOA score were significantly higher than those before surgery(P < 0.05). Occurrence of postoperative complications was correlated with the degree of disc herniation (P < 0.05). Patients with prolapsed LDH were more likely to relapse after surgery (P < 0.05).Conclusion PTED has shorter operation time, less intraoperative blood loss and postoperative complications, so it is a safe and effective surgical option in treating prolapsed LDH. Patients with severe LDH should pay more attention to the prevention of postoperative complications, and indications of patients with prolapsed LDH should be paid more attention when choosing PTED treatment.
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