摘要目的 评价椎间孔镜TESSYS技术治疗腰椎间盘突出症合并Ⅰ°稳定型腰椎滑脱症的效果.方法 腰椎间盘突出症患者32例,年龄51～82岁,体重52～ 93 kg,ASA分级Ⅰ或Ⅱ级,按照是否合并腰椎体滑脱分为2组(n=16):腰椎间盘突出症组(Y组)和腰椎间盘突出症合并Ⅰ°稳定型腰椎体滑脱症组(Y+Z组).在椎间孔镜下2组进行突出物摘除、黄韧带及后纵韧带成型、神经根松解减压术,然后Y+Z组切除增生的骨质和后移的椎体后缘.于术前1d和术后3d、1、3、6、12个月时采用视觉模拟评分法(VAS)评价疼痛程度;分别于术前1d和术后12个月时采用Oswestry功能障碍指数评定患者功能情况;术后12个月时采用Macnab分级评价疗效.结果 与术前1d时比较,2组术后各时点VAS评分降低,术后12个月时Oswestry功能障碍指数降低(P＜0.05);与Y组比较,Y+Z组术后3和6个月时VAS评分升高(P＜0.05),各时点Oswestry功能障碍指数、术后12个月时VAS评分和Macnab分级差异无统计学意义(P＞0.05).结论 椎间孔镜TESSYS技术可用于腰椎间盘突出症合并Ⅰ °稳定型腰椎滑脱症患者的治疗.

abstractsObjective To evaluate the efficacy of transforanminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation complicated with Ⅰ degree stability of lumbar spondylolisthesis.Methods Thirty-two patients with lumbar disc herniation,aged 51-82 yr,weighing 52-93 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were randomly divided into 2 groups (n=16 each) according to whether patients had lumbar spondylolisthesis:lumbar disc herniation group (Y group) and lumbar disc herniation combined with Ⅰ degree stability of lumbar spondylolisthesis group (Y+Z group).Extirpated protrusion,plasty ligamenum flavum and posterior longitudinal ligament and nerve root decompression were carried out using TESSYS technique in two groups,and in addition excision of osseous neoplasias and retro-positioned posterior margin of lumbar vertebral body was done in group Y+Z.Pain was assessed using Visual Analogue Scale (VAS) score at 1 day before surgery and 3 days and 1,3,6 and 12 months after surgery.Patient's function was assessed by using the Oswestry Disability Index (ODI) at 1 day before surgery and 12 months after surgery.The therapeutic effect was evaluated using modified Macnab criteria at 12 months after surgery.Results Compared with the baseline at 1 day before surgery,VAS scores were significantly decreased at each time point after surgery,and ODI was decreased at 12 months after surgery in two groups (P＜0.05).Compared with group Y,VAS scores were significantly decreased at 3 and 6 months after surgery (P＜0.05),and no significant change was found in ODI at each time point or VAS scores and Macnab outcome grade at 12 months after surgery in group Y+Z (P＞ 0.05).Conclusion TESSYS technique can be used to treat lumbar disc herniation complicated with Ⅰ degree stability of lumbar spondylolisthesis.