Percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty for treatment of lumbar disc herniation

doi:10.3969/j.issn.2095-4344.2014.46.007

Abstract

Abstract:

BACKGROUND: Percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty is a minimally invasive therapy for chronic discogenic low back pain, especially suitable for lumbar disc herniation.

OBJECTIVE: To evaluate the safety and short-term efficacy of percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty for treatment of lumbar disc herniation.

METHODS: Thirty-two patients with lumbar disc herniation were subjected to percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty. Visual analogue scale and modified Macnab criteria were used to evaluate the relief of low back pain, and the Oswestry Disability Index was used for daily life evaluation of patients. All the patients were followed for 1-6 months, with an average of 3.5 months.

RESULTS AND CONCLUSION: The operation was successfully completed in all patients, and no complications such as damage to nerve and vascular systems occurred. Low back pain and living ability of the patients were improved obviously. Visual analog scale score and the Oswestry Disability Index were improved significantly after operation (P < 0.01); according to Macnnab's criteria, the results showed that at 1 week after the operation, the effective rate reached 94%; at 3 months after the operation, the effective rate was up to 97%. These findings indicate that percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty in the treatment of lumbar disc herniation is confirmed in the short-term efficacy, and characterized as fewer complications and stable functional recovery.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: intervertebral disk displacement, catheter ablation, diskectomy, percutaneous

CLC Number:

R318

Zhang De-hong, Fang Peng-fei, Yan Yong-hai. Percutaneous transforaminal endoscopic discectomy combined with radiofrequency annuloplasty for treatment of lumbar disc herniation [J]. Chinese Journal of Tissue Engineering Research, 2014, 18(46): 7412-7416.

Figures/Tables 2

2.1 参与者数量分析纳入患者32例，所有患者均获随访，随访时间1-6个月，平均3.5个月，全部进入结果分析。 2.2 患者CT或MRI复查结果所有患者均顺利完成手术，手术时间30-80 min(平均40 min)，术中出血15-50 mL(平均30 mL)，术后住院3-9 d(平均3.9 d)。术后随访时经过CT或MRI复查显示突出的椎间盘明显缩小，其中5例患者术后CT复查未见到突出物明显的还纳缩小现象，但椎间盘内呈现低密度影，椎间盘CT值均有降低。 2.3 患者治疗前后VAS、ODI评分比较 VAS评分法：0分为无痛，1-3分为轻度疼痛，4-6分为中度疼痛，7-10分为重度疼痛。患者治疗后1周及3个月的VAS评分显著低于治疗前，差异有显著性意义(P < 0.01)。治疗后1周及3个月的ODI评分显著低于治疗前，差异有显著性意义(P < 0.01)。但VAS评分、ODI评分在治疗后1周与治疗后3个月比较，差异无显著性意义(P > 0.05)，见表1。 2.4 患者治疗后随访改良Macnab标准评分比较依据改良的Macnab标准：优：疼痛消失，不用服止痛药；良：疼痛明显好转并能入睡，对生活无影响；可：疼痛减轻，夜间仍需服止痛药，影响正常生活；差：疼痛无好转。对治疗后1周及治疗后3月的疗效进行评分(见表2)，结果显示治疗后1周有效率达到94%，治疗后3个月随访时有效率为97%。 2.5 不良反应未出现术前定位错误，术中无神经根硬脊膜损伤，无大出血，无术部感染，无严重过敏反应。术后复发1例，3个月后改行椎板开窗减压手术，术后恢复良好。有8例术后出现短暂性下肢疼痛麻木，考虑日光烧灼综合征，经骶管封闭及康复治疗后症状消失。 2.6 典型病例患者女，46岁。主诉：腰痛伴左下肢放射痛、麻木1年，加重1个月。查体：行走活动跛行，L4、L5椎旁左侧2 cm处压痛阳性，叩击痛阳性，疼痛向左下肢放散至左踝，左小腿前外侧皮肤感觉减退。左下肢直腿抬高试验50°，加强试验(+)。双下肢肌肉无明显萎缩，左侧足背伸肌及足拇背伸肌力Ⅲ级。诊断：L4-5椎间盘突出症。治疗方法及结果：行经皮椎间孔镜下髓核摘除联合射频热凝纤维环成形术，术后症状及体征明显改善，术后当日疼痛即缓解，术后3个月复诊左下肢直腿抬高试验70°，加强试验(-)，左侧足背伸肌肌力及足拇背伸肌力均达到Ⅳ级，复查MRI显示髓核突出部分明显减少，左侧神经根压迫改善见图1。"

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