PERCUTANEOUS DISCECTOMY: A CURRENT TREATMENT FOR LUMBAR DISC HERNIATION

ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1) treated with manual percutaneous nucleotomy (MPN) and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH) treated with (MPN). The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS), Oswestry Disability Index (ODI) and Macnab criteria. Descriptive and inferential statistics for differences. Results: N=110: 58 (52.72%) men, 52 (47.27%) women; average age 37.95 years (14-56) ± 10.60; most affected level: L4-L5 in 63 (57.14%) patients. NPS preoperative average: 7.75 (5-9) ± 1.12, and at 365 days: 2.14 (0-7) ± 2.37. The mean preoperative ODI was 37% (28%-40%) + 3.06, and at 365 days 9.52% (0%-40%) + 13.92. The prognosis (ODI) was good to 79 (71.81%) patients at 365 days, regular in 26 (23.63%) and poor in 5 (4.57%), corresponding respectively to patients with no, mild, moderate and severe disability. The Macnab criteria showed similar results (p = 0.00, 95% CI 0.00 to 0.13 - Student's t). Conclusions: The results were good at one-year follow-up (p = 0.00), demonstrating that the MPN is still a good option for lumbosciatic pain relief.

摘要
研究目的：分析接受手动经皮髓核摘除术（manual percutaneous nucleotomy, MPN）治疗的L4-L5、L5-S1节段包含型腰椎间盘突出症（contained lumbar disc herniation）患者的功能预后情况，验证该术式仍具备良好临床疗效。
研究方法：本研究为前瞻性纵向队列研究，共纳入110例经MPN治疗的腰椎间盘突出症（lumbar disc herniation, LDH）患者。分别于术前、术后4天、30天、180天及365天开展随访评估，评估工具包括数字疼痛评分量表（Numeric Pain Scale, NPS）、Oswestry功能障碍指数（Oswestry Disability Index, ODI）以及Macnab标准。采用描述性统计与推断性统计方法分析组间差异。
研究结果：本研究共纳入110例患者，其中男性58例（52.72%），女性52例（47.27%）；平均年龄37.95岁，年龄区间14~56岁，标准差10.60；最常受累的椎间盘节段为L4-L5，共计63例（57.14%）。术前数字疼痛评分平均为7.75分，评分区间5~9分，标准差1.12；术后365天时平均评分降至2.14分，评分区间0~7分，标准差2.37。术前Oswestry功能障碍指数平均为37%，区间28%~40%，标准差3.06；术后365天时平均指数为9.52%，区间0%~40%，标准差13.92。术后365天时，依据Oswestry功能障碍指数评估，79例（71.81%）患者预后良好，26例（23.63%）预后一般，5例（4.57%）预后较差，分别对应无功能障碍、轻度功能障碍、中度功能障碍及重度功能障碍患者。Macnab标准评估结果与之相符（Student t检验：p=0.00，95%置信区间0.00~0.13）。
研究结论：术后1年随访结果显示临床疗效良好（p=0.00），证实手动经皮髓核摘除术仍是缓解腰腿痛的可靠治疗选择。