Gu Yu-Tong, Cui Zhan, Shao Hong-Wei, Ye Yun, Gu Ai-Qun
Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai, 200032, China.
Department of Orthopaedics, Zhenjiang Hospital of Traditional Chinese and Western Medicine, Zhenjiang, Jiangsu, 212005, China.
J Orthop Surg Res. 2017 Feb 8;12(1):25. doi: 10.1186/s13018-017-0524-0.
We designed an easy posterolateral transforaminal endoscopic decompression technique, termed PTES, for radiculopathy secondary to lumbar disc herniation. The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications.
PTES was performed to treat 209 cases of intracanal or extracanal herniations with or without extruding or sequestrated fragment, high iliac crest, scoliosis, calcification, or cauda equina syndrome including recurrent herniation after previous surgical intervention at the index level or adjacent disc herniation after decompression and fusion. Preoperative and postoperative leg pain was evaluated using the 10-point visual analog scale (VAS) and the results were determined to be excellent, good, fair, or poor according to the MacNab classification at 2-year follow-up.
The patients were followed for an average of 26.3 ± 2.3 months. The VAS score of leg pain significantly dropped from 9 (6-10) before operation to 1 (0-3) (P < 0.001) immediately after the operation and to 0 (0-3) (P < 0.001) 2 years after operation. At 2-year follow-up, 95.7% (200/209) of the patients showed excellent or good outcomes, 2.9% (6/209) fair and 1.4% (3/209) poor. No patients had any form of permanent iatrogenic nerve damage and a major complication, although there were one case of infection and one case of recurrence.
PTES for lumbar disc herniation is an effective and safe method with simple orientation, easy puncture, reduced steps, and little X-ray exposure, which can be applied in almost all kinds of lumbar disc herniation, including L5/S1 level with high iliac crest, herniation with scoliosis or calcification, recurrent herniation, and adjacent disc herniation after decompression and fusion. The learning curve is no longer steep for surgeons.
我们设计了一种简单的后外侧经椎间孔内镜减压技术，称为PTES，用于治疗腰椎间盘突出症继发的神经根病。本研究的目的是描述PTES技术，并评估其治疗腰椎间盘突出症（包括原发性突出、再突出、椎管内突出和椎管外突出）的疗效和安全性，并报告治疗结果及并发症。
采用PTES治疗209例椎管内或椎管外突出症患者，这些患者伴有或不伴有游离或脱垂碎片、高髂嵴、脊柱侧弯、钙化或马尾综合征，包括初次手术部位的复发性突出或减压融合术后相邻椎间盘突出。术前和术后使用10分视觉模拟量表（VAS）评估腿痛情况，并在2年随访时根据MacNab分类法将结果判定为优、良、可或差。
患者平均随访26.3±2.3个月。腿痛的VAS评分从术前的9分（6 - 10分）显著降至术后即刻的1分（0 - 3分）（P < 0.001），并在术后2年降至0分（0 - 3分）（P < 0.001）。在2年随访时，95.7%（200/209）的患者显示优或良的结果，2.9%（6/209）为可，1.4%（3/209）为差。尽管有1例感染和1例复发，但没有患者出现任何形式的永久性医源性神经损伤和严重并发症。
PTES治疗腰椎间盘突出症是一种有效且安全的方法，其定位简单、穿刺容易、步骤减少且X线暴露少，可应用于几乎所有类型的腰椎间盘突出症，包括高髂嵴的L5/S1节段、伴有脊柱侧弯或钙化的突出、复发性突出以及减压融合术后相邻椎间盘突出。对外科医生来说，学习曲线不再陡峭。
