摘要
目的:比较可视化环锯关节突成形辅助下经皮椎间孔镜椎间盘切除术(visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy,VPTED)和传统经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症的临床疗效。方法:对2019年6月至2020年12月收治的60例腰椎间盘突出症患者进行回顾性分析,男38例,女22例;年龄26~58(43.63±8.48)岁;L4,5节段47例,L5S1节段13例。其中32例采用可视化环锯辅助侧路椎间孔镜下髓核摘除术治疗(A组),28例采用传统的逐级环锯下侧路椎间孔镜下髓核摘除术治疗(B组)。记录两组患者一般情况,包括术中透视次数、手术时间、住院时间及随访过程中手术并发症;通过椎间孔中间层面矢状位CT观察关节突成形面积比;采用视觉模拟评分(visual analogue scale,VAS),日本骨科学会(Japanese Orthopaedic Association,JOA)腰痛评分,Oswestry功能障碍指数(Oswestry disability index,ODI)对两组患者的临床疗效进行评定。结果:所有患者获得随访,时间为9~15(12.10±1.16)个月。两组患者术前一般资料比较差异无统计学意义。A组手术时间、术中透视次数、住院时间分别是(70.47±5.87)min、(13.66±1.34)次、(6.31±0.69)d,而B组为(90.71±7.66)min、(22.82±2.48)次、(6.54±0.92)d,A组的手术时间及术中透视次数少于B组(P<0.05),两组患者住院时间比较差异无统计学意义(P>0.05)。两组患者随访过程中均未见明显手术并发症。A组和B组关节突成形面积比分别为(29.72±2.84)%、(29.57±2.20)%,差异无统计学意义(P>0.05)。两组患者术前及末次随访时的VAS、ODI、JOA评分比较,差异均无统计学意义(P>0.05),末次随访较术前均明显改善(P<0.05)。结论:两种手术方式治疗腰椎间盘突出症临床疗效确切,可视化环锯辅助侧路椎间孔镜下髓核摘除术在建立通道时具有高效快捷的优势,可显著降低手术时间及术中透视次数。
Objective To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy(VPTED)and traditional percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation.Methods The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December,2020 was retrospectively analyzed.There were 38 males and 22 females,aged from 26 to 58 years old with an average of(43.63±8.48)years,47 cases were on L4,5 segment and 13 cases were on L5S1 segment.Among them,32 were treated with VPTED(group A)and 28 were treated with traditional PTED(group B).The general conditions of all the patients were recorded,including intraoperative fluoroscopy times,operation time,hospital stay and surgical complications during follow-up.The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen.Visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score of low back pain,Oswestry disability index(ODI)were used to evaluate the clinical efficacy between two groups.Results All patients were followed up from 9 to 15 months with an average of(12.10±1.16)months.There was no statistical difference of preoperative general data between two groups.The operation time,fluoroscopy times and hospital stay were(70.47±5.87)min,(13.66±1.34)times and(6.31±0.69)d in group A,and(90.71±7.66)min,(22.82±2.48)times and(6.54±0.92)d in group B.The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(P<0.05).There was no significant difference in hospital stay between two groups(P>0.05).No obvious surgical complications were found during the follow-up in both groups.The arthroplasty area ratio in group A was(29.72±2.84)%and(29.57±2.20)%in group B,respectively,with no significant difference(P>0.05).There was no significant difference in VAS,ODI and JOA score between two groups before operation and at the final follow-up(P>0.05),but the final follow-up was significantly improved(P<0.05).Conclusion The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation.Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel,and can significantly reduce the operation time and intraoperative fluoroscopy times.
作者
钟伟建
黎顺平
王云娜
邓晓波
洪忠
卢志有
ZHONG Wei-jian;LI Shun-ping;WANG Yun-na;DENG Xiao-bo;HONG Zhong;LU Zhi-you(Department of Orthopaedics,the First People's Hospital of Nankang District,Ganzhou341000,Jiangxi,China;Department ofRehabilitation,the First People's Hospital of Nankang District,Ganzhou341000,Jiangxi,China)
出处
《中国骨伤》
CAS
CSCD
2023年第1期12-16,共5页
China Journal of Orthopaedics and Traumatology
基金
赣州市指导性科技计划项目(编号:GZ2019ZSF339)。
关键词
腰椎
椎间盘移位
椎间盘摘除术
外科手术
内窥镜
Lumbar vertebrae
Intervertebral disk displacement
Diskectomy
Surgical procedures,endoscopic
