目的 观察经皮椎间孔镜(precutaneous endoscopic transforaminal discectomy,PETD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效及其并发症。方法 由同一名医师完成的经非手术治疗无效或复发的单节段LDH患者83例,其中L_4-5 52例,L₅-S₁ 31例,包容型64例,非包容型19例。观察术前、术后第一天及末次随访时患肢疼痛视觉模拟评分(visual analog scale ,VAS), Oswestry功能障碍指数(oswestry Disability Index ,ODI)评定和改良MacNab标准,评价临床疗效。结果 83例均获6～15个月随访,术后第一天及末次随访VAS分别为(10.3±2.1),(9.6±1.4),均低于术前(75.8±2.3)分(P＜0.01);末次随访ODI指数为(10.4±2.0)%,低于术前(68.8±14.6)％ (P＜0.01) 。根据改良Macnab标准:优61例,良6例,可5例,差11例。术后复发10例,6例行二次开放TLIF手术治疗;1例发生脑脊液漏,加压包扎后痊愈。结论 PETD是LDH安全、有效、微创治疗方法,但手术医师术前应充分考虑术中、术后并发症及其影响因素。

Objective To study the efficacy and complications of percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation. Methods : from September 2011 to October 2012, 83 patients received invalid conservative treatment or recurrent single segmental lumbar disc herniation performed by the same physician, including L4/5 52 cases, L5/S1 31cases, containment 42 cases and non- containment 19 cases. The limb pain visual analog scale (VAS), Oswestry Disability Index function (ODI) and modified MacNab criteria were observed at the time of the preoperative and post-operative first day and last follow-up to assess the clinical efficacy. Results 83 cases were followed up for 8 to 15 months, the VAS of the post-operative first day and the last follow-up were (10.3?2.1) and (9.6?1.4) respectively, which were significantly lower than the preoperative (75.8?2.3) (P<0.01), the last follow-up ODI index was (10.4?2.0)%, lower than the preoperative (68.8?14.6)% (P=0.004). According to the modified Macnab criteria: the therapeutic outcome was excellent in 61 cases, good in 6 cases, fair in 5 cases, and poor in 11 cases. 10 cases of postoperative recurrence (12%) and 6 cases with secondary open TLIF; 1 case of cerebrospinal fluid leakage, healed after pressure bandaging.Conclusions The PETD is of mini-invasive, safe and effective.However,the surgeon should take full account of the intra-operative and post-operative complications and influencing factors before operation.