经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症伴或不伴腰椎神经根管狭窄的疗效观察

摘要

目的 观察经椎间孔镜技术即TESSYS技术(Transforaminal Endoscopic Spine System)治疗腰椎间盘突出症伴或不伴腰椎神经根管狭窄的疗效.方法 2015年10月~2016年5月行TESSYS技术治疗腰椎间盘突出22例,其中15例伴腰椎神经根管狭窄.局麻下行突出髓核摘除、椎间孔成形及神经根管减压术.结果 术前腰痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)分别为(7.18±0.84)分和(36.50±3.90)分,术后6个月随访时分别为(2.59±0.81)分和(18.95±2.57)分,明显改善(配对t检验,t=30.72、25.57,P=0.00、0.00).随访6~12个月,末次随访根据改良MacNab评价标准,优6例(27.3%),良12例(54.5%),可3例(13.6%),差1例(4.5%),优良率81.8%.结论 经皮椎间孔镜TESSYS技术在摘除突出髓核的同时能够充分对狭窄的神经根管进行减压,能够有效应用于腰椎间盘突出伴神经根管狭窄患者.%Objective To observe the effect of Transforaminal Endoscopic Spine System ( TESSYS ) in the treatment of lumbar disc herniation with or without lumbar nerve root canal stenosis . Methods We selected 22 cases of lumbar disc herniation treated with TESSYS from October 2015 to May 2016, including 15 cases of lumbar nerve root canal stenosis .The TESSYS surgery included removal of nucleus pulposus intervertebral and foramen forming and nerve root canal decompression under local anesthesia . Results Preoperative visual analogue scale ( VAS) score of low back pain and the Oswestry disability index ( ODI) of 22 patients were (7.18 ±0.84) points and (36.50 ±3.90) points, which were significant improved at 6 months after surgery [(2.59 ±0.81) points and (18.95 ±2.57) points, t=30.72 and 25.57, P=0.00 and 0.00, respectively].Follow-ups were conducted for 6-12 months.According to modified MacNab criteria, there were 6 cases (27.3%) of excellent results, 12 cases (54.5%) of good results, 3 cases (13.6%) fine, and 1 case (4.5%) poor, with an excellent and good rate of 81.8%. Conclusions The TESSYS surgery can effectively remove the prominent nucleus pulposus with the nerve root canal fully decompressed .Therefore , the technique can be effectively applied to patients with lumbar disc herniation with nerve root canal stenosis .