He Shenghua, Sun Zhitao, Wang Yeguang, Ma Dujun, Tan Weiwei, Lai Juyi
Department of Orthopedics, Shenzhen Traditional Chinese Hospital, Guangzhou University of Chinese Medicine, Shenzhen Anhui University of Chinese Medicine, Hefei Guangzhou University of Chinese Medicine, Guangzhou, China.
Medicine (Baltimore). 2018 Jul;97(28):e11240. doi: 10.1097/MD.0000000000011240.
The authors retrospectively characterized the clinical outcomes of combining the Yeung endoscopic spine system (YESS) and transforaminal endoscopic surgical system (TESSYS) techniques during percutaneous transforaminal endoscopic discectomy (PTED) to treat multilevel lumbar disc herniation.PTED using both YESS and TESSYS was performed on 52 patients with multilevel lumbar disc herniations who had shown no apparent response to previous conservative treatments. Postsurgical follow-ups were conducted at weeks 1, 26, and 48. Patients' preoperative and postoperative performances were assessed by modified MacNab classification, Japanese Orthopedic Association (JOA) scores, Oswestry disability index (ODI), and visual analog scale (VAS), and compared with 34 and 45 patients who were treated only by YESS and TESSYS, respectively.The postsurgery surgeon-performed assessment showed satisfactory results in 98% of the YESS + TESSYS-treated cases. The average operative time was 116 ± 23 minutes, intraoperative bleeding was 19 ± 12 mL, and bed stay was 3 days. No complications occurred, including infection, nerve injury, or spinal canal hematoma. One week after surgery, the modified MacNab classifications of the patients were excellent in 45, good in 6, fair in 1, and poor in 0 (98% were excellent or good). JOA, ODI, and VAS scores for low back pain significantly improved relative to the preoperative assessment (P < .01) and had remained stable at 26 and 48 weeks.PTED that combined YESS and TESSYS techniques, depending on the predominant type of lumbar disc herniation at individual levels, is safe, minimally invasive, and effective.
作者回顾性分析了在经皮椎间孔镜椎间盘切除术（PTED）中联合使用杨式内镜脊柱系统（YESS）和经椎间孔内镜手术系统（TESSYS）技术治疗多节段腰椎间盘突出症的临床结果。对52例多节段腰椎间盘突出症且先前保守治疗无明显效果的患者实施了同时使用YESS和TESSYS的PTED。术后分别在第1、26和48周进行随访。通过改良MacNab分类法、日本骨科协会（JOA）评分、Oswestry功能障碍指数（ODI）和视觉模拟量表（VAS）评估患者术前和术后的表现，并分别与34例仅接受YESS治疗和45例仅接受TESSYS治疗的患者进行比较。术后外科医生进行的评估显示，在YESS + TESSYS治疗的病例中，98%的结果令人满意。平均手术时间为116±23分钟，术中出血19±12毫升，住院时间为3天。未发生包括感染、神经损伤或椎管血肿在内的并发症。术后1周，患者的改良MacNab分类为优45例、良6例、可1例、差0例（98%为优或良）。与术前评估相比，JOA、ODI和下腰痛的VAS评分显著改善（P <.01），并在26周和48周时保持稳定。根据各节段腰椎间盘突出症的主要类型联合YESS和TESSYS技术的PTED是安全、微创且有效的。
