Peng Chan Wearn Benedict, Yeo William, Tan Seang Beng
Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
J Spinal Disord Tech. 2010 Aug;23(6):425-30. doi: 10.1097/BSD.0b013e3181b3f862.
Prospective study
To determine the clinical outcomes and the effect on quality of life of patients with endoscopic discectomy.
Percutaneous endoscopic discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and return to the work.
Fifty-five patients with percutaneous endoscopic discectomy performed from the year 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS), Medical Outcomes Study Short Form-36 (SF-36) scores and Pain Visual Analog Scale (VAS) and return to the work.
The mean age was 35.6 years, the mean operative time was 60 minutes and the mean length of follow-up was 3 years. The mean hospital stay for endoscopic discectomy was 17 hours. There was statistical difference in the reduction of severity of back pain and lower-limb symptoms (NASS and VAS, P<0.05) at 6 months and 2 years. There was significant improvement in all aspects of the quality of life (SF-36, P<0.05) scores except for general health at 6 months and 2 years postoperation. The improvement in the SF-36 quality of life parameters correlated with the improvement in the NASS back disability and neurogenic symptoms and the VAS leg and back pain scores. The recurrence rate was 5% (3 patients). The 5% patients (3 patients) subsequently underwent lumbar fusion for persistent back pain. All patients returned to their previous occupation after surgery at a mean time of 24 days.
Endoscopic discectomy is associated with improvement in back pain and lower-limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with shorter length of hospitalization and early return to work thus improving quality of life earlier.
前瞻性研究
确定接受内镜下椎间盘切除术患者的临床疗效及对生活质量的影响。
经皮内镜下椎间盘切除术是一项相对较新的技术。极少有研究报道经皮内镜下椎间盘切除术在生活质量和恢复工作方面的临床疗效。
对2002年至2006年期间接受经皮内镜下椎间盘切除术的55例患者，依据北美脊柱评分（NASS）、医学结局研究简明健康调查量表（SF - 36）评分、疼痛视觉模拟量表（VAS）以及恢复工作情况对其临床疗效进行评估。
平均年龄为35.6岁，平均手术时间为60分钟，平均随访时间为3年。内镜下椎间盘切除术的平均住院时间为17小时。术后6个月和2年时，背痛和下肢症状严重程度的减轻（NASS和VAS，P<0.05）存在统计学差异。术后6个月和2年时，除总体健康外，生活质量各方面（SF - 36，P<0.05）评分均有显著改善。SF - 36生活质量参数的改善与NASS背部功能障碍和神经源性症状的改善以及VAS腿部和背部疼痛评分的改善相关。复发率为5%（3例患者）。这5%的患者（3例）随后因持续性背痛接受了腰椎融合术。所有患者术后平均在24天回到原工作岗位。
内镜下椎间盘切除术与术后背痛和下肢症状的改善相关，进而转化为生活质量的提高。其优点在于可在日间手术的基础上进行，住院时间较短且能早期恢复工作，从而更早地改善生活质量。
