目的 探讨经皮椎间孔内镜下椎间盘切除术治疗腰椎间盘突出症的临床疗效.方法 2011年3月～2011年7月应用经皮椎间孔内镜下椎间盘切除术治疗21例腰椎间盘突出症患者,术前患者均表现为腰痛伴单侧下肢放射性疼痛,均为单间隙突出,外侧型突出19例(椎间孔外型9例,椎间孔内型10例),旁中央型突出2例.术前、术后不同时间对患者腰腿痛进行视觉模拟评分(VAS)评分,末次随访时采用Oswestry功能障碍指数(ODI)评价疗效.结果 21例患者均成功实施手术,手术时间65～130m in,平均85 min.术中出血5～30 mL,平均12 mL.1例L5/S1患者术后症状未缓解,改开放手术.随访3～6个月,平均4.2个月,无复发病例.腰痛、腿痛VAS由术前的(6.53±1.68)、(8.37±1.63)分下降到末次随访时的(2.15±1.27)、(1.82±0.75)分,与术前比较差异均有显著性(P＜0.01).按Oswestry功能障碍指数(ODI)评价疗效,优良率达90.5％.结论 经皮椎间孔内镜下椎间盘切除术治疗腰椎间盘突出症,特别是极外侧型突出,可获得较好的临床效果.%[Objective] To evaluate the primary outcome of percutaneous transforaminal endoscopic lumbar discectomy for lumbar disc herniation. [Method] 21 patients who had lumbar disc herniation and underwent transforaminal microendoscopic discectomy were reviewed retrospectively from March to July 2011. All patients presented with back pain and sciatica of varied degrees had single level involved. The pathological type of disc herniation included lateral type in 19 cases and paramidian type in 2 cases. The preoperative and postoperative visual analogue scale (VAS) were used to evaluate the leg pain and the back pain. Oswestry disability index (ODI) at final follow-up were also evaluated. [Result] All cases underwent operation successfully. The operation time was 65-130 min (mean 85min) and the blood loss was 5-30 mL (average 12 mL). 1 case with L5/S1 lumbar disc herniation was unrelieved after operation, and experienced open surgery. The follow-up was 3-6 months (mean 4.2 months). No recurrence was noted thereafter. All patients had VAS score of low back and leg pain decreased from preoperative (6.53±1.68) and (8.37±1.63) to postoperative (2.15±1.27) and (1.82±0.75), respectively at final follow-up, which showed significant difference between preoperative and postoperative (P ＜0.01). The surgical outcomes showed good clinical outcomes with the excellent-to-good rate of 90.5% according to Oswestry disability index (ODI) criteria. [Conclusion] Percutaneous transforaminal endoscopic lumbar discectomy for lumbar disc herniation especially lateral type presents good clinical outcomes due to its minimal invasion.
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