CAJ | 학술논문

目的：探讨椎间孔镜TESSYS技术治疗腰椎间盘突出症的疗效。方法将腰椎间盘突出症患者31例，包括L342例，L4521例，L5S18例采用椎间孔镜TESSYS技术治疗。局部浸润麻醉、透视下靶向穿刺至病变节段的椎间孔外侧，环锯逐级扩大椎间孔，经椎间孔安置工作通道至椎管内，镜下摘除突出到椎管内的髓核和椎间隙内松动的髓核，直至神经根和硬膜囊完全松解，切口缝合1针。术后随访6～12个月。结果均未发生神经损伤等严重并发症，27例顺利摘除突出髓核，神经根显露清晰。首例极外侧突出和第2例中央型突出摘除髓核后未显露神经根，术后症状均缓解。第3、11例分别因巨大突出取出困难、不能耐受疼痛中转全麻椎间盘镜手术。术后当天至2d下地活动，患者均感症状明显缓解。术后2周复发突出1例，保守治疗好转。末次随访时视觉模拟评分（VAS）腿痛由8.1±1.9降至1.1±0.9，Oswestry功能障碍指数（ODI）自31.1±8.3降至3.4±3.3。根据MacNab评分，优25例，良6例。结论椎间孔镜TESSYS技术治疗腰椎间盘突出症创伤小、恢复快，效果优良，但存在学习曲线。
목적：탐토추간공경TESSYS기술치료요추간반돌출증적료효。방법장요추간반돌출증환자31례，포괄L342례，L4521례，L5S18례채용추간공경TESSYS기술치료。국부침윤마취、투시하파향천자지병변절단적추간공외측，배거축급확대추간공，경추간공안치공작통도지추관내，경하적제돌출도추관내적수핵화추간극내송동적수핵，직지신경근화경막낭완전송해，절구봉합1침。술후수방6～12개월。결과균미발생신경손상등엄중병발증，27례순리적제돌출수핵，신경근현로청석。수례겁외측돌출화제2례중앙형돌출적제수핵후미현로신경근，술후증상균완해。제3、11례분별인거대돌출취출곤난、불능내수동통중전전마추간반경수술。술후당천지2d하지활동，환자균감증상명현완해。술후2주복발돌출1례，보수치료호전。말차수방시시각모의평분（VAS）퇴통유8.1±1.9강지1.1±0.9，Oswestry공능장애지수（ODI）자31.1±8.3강지3.4±3.3。근거MacNab평분，우25례，량6례。결론추간공경TESSYS기술치료요추간반돌출증창상소、회복쾌，효과우량，단존재학습곡선。
Objective To investigate the value of percutaneous transforaminal endoscopic spine system (TESSYS) in lumbar discectomy for disc herniation. Methods Thirty one patients with lumbar disc herniation were treated with TES-SYS and followed up 6-12 months. The involved levels of vertebral segment included L34 (2 cases), L45 (21 cases) and L5S1 (8 cases). The targeted puncture was performed under local anesthesia and fluoroscopic guidance. The foramen of involved level of vertebral segment was enlarged gradually with four trephinations, and the working cannula was inserted transforaminal in-to the canal. Then the herniation was exposed and removed with full endoscopic technique, including the loosen nucleus pulposus. The nerve root and dural sac were exposed and released adequately. Results The procedure was evenly carried out in 27 cases. After discectomy, the nerve roots were complete released, and not exposed in the first case of far lateral herni-ation and the second case of central herniation. The third case and eleventh case converted to microendoscopic discectomy, due to large herniation and intraoperative pain, respectively. The patients could walk in the same day, 1 or 2 days after opera-tion, with obvious relief of leg pain. One case of recurrence was found at 2 weeks after operation, who was treated conserva-tively. At the final follow-up, the visual analogue scale of leg pain decreased from 8.1±1.9 to 1.1±0.9, and the Oswestry dis-ability index (ODI) decreased from 31.1±8.3 to 3.4±3.3. According to MacNab scale, there were excellent results in 25 cases and good results in 6 cases. Conclusion The percutaneous endoscopic TESSYS is a good minimal invasive technique for lumbar discectomy, with good results and a learning curve.