经皮内窥镜下腰椎间盘切除术中椎间孔成形的适应证研究被引量：3

A clinical study of indications of foraminoplasty in percutaneous endoscopic lumbar discectomy

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摘要目的:探讨经皮内窥镜下腰椎间盘切除术中椎间孔成形的适应证。方法:选取经椎间孔入路行经皮内窥镜下腰椎间盘切除术的单节段腰椎间盘突出症患者,其中36例患者术中进行了椎间孔成形(椎间孔成形组),50例患者术中未进行椎间孔成形(椎间孔未成形组)。在患者术前的CT图像上测定病变节段的椎间隙高度、椎间孔宽度、椎板角,在术前X线片上测定患者的髂嵴高度,在术前MRI上测定突出椎间盘的下移程度。结果:椎间孔成形组椎间隙高度低于椎间孔未成形组[(5.92±1.22)mm,(6.74±0.92)mm,t=-3.555,P=0.004],突出椎间盘向下重度移位者所占比例高于椎间孔未成形组(P=0.031);2组患者的椎间孔宽度、椎板角及髂嵴高度比较,组间差异均无统计学意义[(6.92±1.03)mm,(7.07±1.20)mm,t=-0.606,P=0.566;99.52°±10.62°,98.23°±8.77°,t=0.616,P=0.739;(33.38±1.06)mm,(32.69±2.24)mm,t=1.713,P=0.164]。L5S1腰椎间盘突出症患者中,椎间孔成形组的椎间隙高度、椎间孔宽度均小于椎间孔未成形组[(4.13±1.22)mm,(5.19±0.92)mm,t=-3.198,P=0.006;(5.89±1.38)mm,(7.28±1.28)mm,t=-3.387,P=0.002],髂嵴高度大于椎间孔未成形组[(35.26±3.44)mm,(32.78±2.86)mm,t=2.549,P=0.001];2组患者的椎板角、突出椎间盘下移程度比较,组间差异均无统计学意义(96.52°±8.62°,95.23°±6.77°,t=0.542,P=0.173;P=0.476)。中央型腰椎间盘突出症患者中,椎间孔成形组的椎间隙高度小于椎间孔未成形组[(5.66±0.75)mm,(6.93±0.92)mm,t=-3.499,P=0.006],椎板角大于椎间孔未成形组(103.58°±5.32°,92.38°±4.37°,t=5.426,P=0.001);2组患者的椎间孔宽度、髂嵴高度、突出椎间盘下移程度比较,组间差异均无统计学意义[(5.86±1.46)mm,(7.18±1.41)mm,t=-2.152,P=0.472;(33.25±2.01)mm,(34.03±1.63)mm,t=0.289,P=0.775;P=0.455]。结论:病变节段椎间隙狭窄的腰椎间盘突出症、突出物向下移位严重的腰椎间盘突出症、髂嵴较高的L5S1椎间盘突出症、病变节段椎板角较大的中央型腰椎间盘突出症,均应视为经皮内窥镜下腰椎间盘切除术中椎间孔成形的适应证。 Objective： To explore the indications of foraminoplasty in percutaneous endoscopic lumbar discectomy（PELD） . Methods： Eighty - six patients with single - segment lumbar disc herniation（ LDH） who received PELD through intervertebral foramina approach were selected. The foraminoplasty was performed on 36 patients （foraminoplasty group） and was not performed on 50 patients （non - foraminoplas-ty group） during the PELD. The intervertebral space height,the intervertebral foramina width and the vertebral plate angle of diseased seg-ment were measured on patients,preoperative CT images. The iliac crest height and the downward - displacement degree of herniated inter-vertebral disc were measured on patients, preoperative CT images and preoperative MRI respectively. Results ： The intervertebral space heights were lower, and the proportion of patients with severe downward - displacement of herniated intervertebral discs was higher in foraminoplasty group compared to non - foraminoplasty group（5.92 ＋/- 1.22 vs 6. 74 ＋/- 0. 92 mm, t = - 3. 555 ,P = 0. QQ4;P = 0. 031）. There was no statistical difference in intervertebral foramina width, vertebral plate angle and iliac crest height between foraminoplasty group and non - foraminoplasty group（6. 92 ＋/- 1.03 vs 7. 07 ＋/- 1.20 mm,t = - 0. 606 = 0. 566;99. 52 ＋/- 10. 62 vs 98. 23 ＋/- 8. 77 de-grees ,t =0. 616,P =0. 739; 33. 38 ＋/- 1.06 vs 32. 69 ＋/- 2. 24 mm, ^ = 1. 713,P =0. 164）. For patients with L5 - S1 LDH, the interverte-bral space heights and the intervertebral foramina widths were smaller and the iliac crest heights were greater in foraminoplasty group com-pared to non - foraminoplasty group（4. 13 ＋/- 1.22 vs 5. 19 ＋/-0. 92 mm,t = - 3. 198 =0. 006 ;5. 89 ＋/- 1.38 vs 7. 28 ＋/- 1.28 mm,t = - 3. 387 = 0. 002 ; 35. 26 ＋/ - 3.44 vs 32. 78 ＋/ - 2. 86 mm = 2. 549 = 0. 001 ） , while there was no statistical difference in verte-bral plate angle and downward - displacement degree of herniated intervertebral discs between foraminoplasty group and non - foraminoplas- ty group（96. 52 ＋/- 8. 62 vs 95.23 ＋/- 6. 77 degrees,t =0. 542 =0. 173 ;P = 0.476） . For patients with central - type LDH,the interver-tebral space heights were smaller and the vertebral plate angles were larger in foraminoplasty group compared to non - foraminoplasty group（5.66 ＋/-0.75 vs 6. 93 ＋/-0. 92 mm,t = - 3. 499,P=Q. 006; 103. 58 ＋ / -5 . 32 vs 92. 38 ＋ / -4 . 37 degrees,t = 5. 426,P = 0 .0 0 1 ） ,while there was no statistical difference in intervertebral foramina width, iliac crest height and downward - displacement degree of herniated intervertebral discs between foraminoplasty group and non - foraminoplasty group（5. 86 ＋/- 1.46 vs 7. 18 ＋/- 1.41 mm,Z = - 2. 152,P = 0. 472 ; 33. 25 ＋/-2. 01 vs 34. 03 ＋/- 1.63 mm, t = 0. 289,P = 0. 775 ;P =0. 455 ） . Conclusion： LDH with narrow intervertebral space at diseased segment,LDH with severe downward displacement of herniated disc,L5 - Sl LDH with high iliac crest and central - type LDH with large vertebral plate angle at diseased segment should be regarded as the indications of foraminoplasty in PELD.

作者陈华李红卫李宇卫沈晓峰陆斌杰 CHEN Hua;LI Hongwei;LI Yuwei;SHEN Xiaofeng;LU Binjie(Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009,Jiangsu,China)

机构地区江苏省苏州市中医医院

出处《中医正骨》 2018年第4期8-12,共5页 The Journal of Traditional Chinese Orthopedics and Traumatology

基金江苏省苏州市临床重点病种诊疗技术专项项目(LCZX201513)

关键词椎间盘移位腰椎内窥镜检查椎间孔适应证 intervertebral disc displacement lumbar vertebrae endoscopy intervertebral foramina indicatio

分类号 R687.3 [医药卫生—骨科学]

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参考文献4

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