经皮椎间孔镜联合射频臭氧消融术治疗合并高信号区腰椎间盘突出症的临床疗效

Percutaneous endoscopic lumbar discectomy combined with radiofrequency and ozone ablation for lumbar disc herniation with HIZ

摘要:

目的 观察运用经皮椎间孔镜（PELD）联合射频臭氧消融术治疗合并高信号区（HIZ）腰椎间盘突出症（LDH）的临床疗效。方法 回顾性分析该科2016年1月－2018年1月完成PELD联合射频消融手术的患者资料，最终纳入具有完整随访资料的患者37例。其中，男21例，女16例；年龄32～70岁，平均52.5岁。分别于术前、出院时、术后1个月和末次随访时采用视觉模拟评分法（VAS）记录患者腰腿痛情况、Oswestry功能障碍指数评分（ODI）评估腰椎功能改善情况和改良MacNab标准评价患者的手术疗效。结果 手术时间60～120 min，平均75 min；出血5～10 mL，平均6 mL。术中无硬膜囊撕裂、脑脊液漏、椎间盘炎等并发症出现；术后3个月1例患者同节段复发，予以椎间孔镜翻修。所有患者随访12～24个月，平均16.8个月。37例患者术前腰、腿痛VAS评分分别为（7.83±1.26）和（8.25±0.23）分、出院时为（2.80±1.34）和（3.07±1.25）分、术后1个月为（2.14±1.15）和（2.38±1.27）分、末次随访为（2.05±0.79）和（1.64±0.52）分；术前ODI评分为（75.31±15.34）分、出院时为（28.14±8.53）分、术后1个月为（16.16±7.58）分、末次随访为（11.42±4.13）分，术前术后比较，差异均有统计学意义（P < 0.05）。改良MacNab标准评价临床疗效，其中优30例、良5例、可1例、差1例，优良率为94.59%。结论 PELD联合射频臭氧消融术治疗合并HIZ的LDH疗效确切，患者腰腿痛症状均明显改善，且具有创伤小、出血少、恢复快、术后并发症少和安全性高等优点，值得临床推广。

Abstract:

Objective To observe the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) combined with radiofrequency and ozone ablation for double-segment lumbar disc herniation (LDH) with HIZ.Methods We retrospectively analyzed the clinical data of 37 patients of LDH with HIZ who underwent percutaneous transforaminal endoscopicdiscectomy combined with radiofrequency ablation from January 2016 to January 2018. Including 21 males and 16 females, aged 32～70 years (average 52.5 years old). Visual analogue scale/score (VAS) was used to record lumbago and leg pain before operation, at discharge, at one month after operation and at the last follow-up. Oswestry disability index (ODI) was used to evaluate the improvement of lumbar spine function and modified MacNab criterion was used to evaluate the surgical effect.Results The operation time was 60～120 min, with an average of 75 min; The bleeding volume was 5～10 mL, with an average of 6 mL. There were no complications such as dural sac tear, cerebrospinal fluid leakage, discitis during the operation. 1 patient relapsed at the same segment at 3 months after the operation and underwent revision of the PELD. All the patients were followed up for 12～24 months, with an average of 16.8 months. The VAS scores of lumbago and leg pain in 37 patients were (7.83 ± 1.26) and (8.25 ± 0.23) score before operation, (2.80 ± 1.34) and (3.07 ± 1.25) score at discharge, (2.14 ± 1.15) and (2.38 ± 1.27) score at one month after operation, (2.05 ± 0.79) and (1.64 ± 0.52) score at the last follow-up. The ODI scores were (75.31 ± 15.34) score before operation, (28.14 ± 8.53) score at discharge, and (16.16 ± 7.58) score at one month after operation, (11.42 ± 4.13) score at the final follow-up, The difference was statistically significant before and after operation (P < 0.05). The improved MacNab criterion to evaluate the clinical efficacy, 30 cases with excellent, 5 cases with good, 1 case with fair and 1 case with poor. The excellent and good rate was 94.59%.Conclusion PELD combined with radiofrequency and ozone ablation is effective in the treatment of for lumbar disc herniation with HIZ. The symptoms of lumbar and leg pain are improved well. It has the advantages of less trauma, less bleeding, faster recovery and fewer complications,high safety. It is worthy of clinical promotion.