经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症18例的近期疗效.docVIP

经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症18例的近期疗效 　　摘要：目的 评估经皮椎间孔镜 　　关键词：椎间孔镜；腰椎间盘突出症；射频消融 　　The efficacy of 18 Patients with Disc Herniation Percutaneous Transforaminal Endoscopic Discectomy for Lumbar TESSYS 　　HUA Guo-tian，YUAN Zhi-gang，LAI Mao-wen 　　（Dongcheng District peoples Hospital of City，Dongguan，523007，Guangdong，China） 　　Abstract：Objective To evaluate the preliminary clinical outcomes of percutaneous transformational endoscope discectomy（PTED）in treating lumbar disc herniation after conservative treatment.Methods Totally 18 patients with single lumbar disc herniation failed in conservative treatment and then received posterolateral （PTED Clinical outcomes were evaluated by visual analogue scale（VAS），Oswestry disability index（ODI）and modified Macnab criteria before and after the operation.Results The postoperative VAS scores（3.6±0.8，3.2±0.7，2.5±0 .6 at 1 day，1 week and 1 months）were significantly lower than preoperative one（8.74±1 4 ， P0.01）The postoperative ODI（32.2%±8.2%，21.3%±4.9%，18.8%±8.3%at 1 day，1 week， 1 months）were also significantly lower than preoperative one（82.2%±12.6%，P0.01）.According to the modified Macnab criteria，the therapeutic outcome was excellent in 7 cases，good in 9，fair in 2，and poor in 0.Transient nerve palsy occurred in one patient on day 1 after operation and disappeared after 3 days without special treatment.Conclusion The preliminary study shows that PTED is safe and effective in treating lumbar discherniation. 　　Key words：Transformational endoscope；Lumbar intervertebral disc herniation；Radiofrequency 　　腰椎间盘脱出症（lumbar disc herniation， LDH）是临床的常见病，多发病，其治疗方法和疗效一直是外科医生的一个热门话题。在脊柱手术，后路切开手术方法被广泛应用于LDH的治疗。用更新的技术和手术器械的进步，微创手术已逐渐应用于临床，椎间孔镜（椎间孔镜下脊柱内固定系统， TESSYS ）技术是目前比较流行的微创技术。 　　1资料与方法 　　1.1一般资料 　　1.2手术器械 THESSYS脊椎椎间孔内窥镜系统（德国齐柏林公司）和熔化温度低的射频机（埃尔曼公司在美国） 。 　　1.3方法 手术卫生床边，患者腰垫，使腰椎后正中线上平行于床面。静脉滴注氟比洛芬酯100 mg辅助镇痛，必要时1～2 mg静脉注射咪达唑仑镇静适中。术前用定位网络下的C形臂X线透视确定椎间盘体表投影和标记病理变化。取髂前上棘1公分责任的椎间盘水平线上和脊柱中线附近后10～12 cm为进针点开放。皮下至肌层注射1%利多卡因行穿刺的方法一步步浸润麻醉。穿刺针与躯干矢状面成10°～20