椎间孔镜可视环锯治疗L5～S1腰椎间盘突出症的有效性和安全性

Efficacy and safety of percutaneous transforaminal endoscopic discectomy with trepan in the treatment of L5-S1 disc herniation

摘要:

目的 分析椎间孔镜可视环锯治疗L₅～S₁腰椎间盘突出症（LDH）的有效性和安全性。方法 选取2020年1月—2021年12月亳州市人民医院收治的80例L₅～S₁节段LDH患者，随机分为研究组、对照组，每组40例。患者均行经皮椎间孔镜术，研究组使用可视环锯，对照组使用骨钻，术后随访6个月。对比两组患者手术情况、疼痛及腰椎功能情况，比较两组患者手术效果、手术节段影像学指标及术后并发症情况。结果 研究组通道建立时间、手术时间短于对照组，透视次数少于对照组，上关节突骨去除量多于对照组（P <0.05）。两组患者镜下操作时间、术中出血量比较，差异无统计学意义（P >0.05）。两组患者术前、术后7 d、术后1个月、术后3个月的VAS评分比较，经重复测量设计的方差分析，结果 ①不同时间点VAS评分有差异（P <0.05），术后均低于术前（P <0.05）；②两组患者VAS评分无差异（P <0.05）；③两组患者VAS评分变化趋势无差异（P >0.05）。两组患者术前、术后3个月、术后6个月的JOA评分、ODI比较，经重复测量设计的方差分析，结果 ①不同时间点JOA评分、ODI有差异（P <0.05），术后JOA评分均高于术前（P <0.05），ODI均低于术前（P <0.05）；②两组患者JOA评分、ODI无差异（P >0.05）；③两组患者JOA评分、ODI变化趋势无差异（P <0.05）。两组患者疗效比较，差异无统计学意义（P <0.05）。两组患者术前、术后3个月、术后6个月的手术节段水平位移、角位移比较，经重复测量设计的方差分析，结果 ①不同时间点间的手术节段水平位移、角位移无差异（P >0.05）；②两组患者手术节段水平位移、角位移无差异（P >0.05）；③两组手术节段水平位移、角位移变化趋势无差异（P >0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 经皮椎间孔镜可视环锯治疗L₅～S₁ LDH是安全、有效的，具有通道建立时间及手术时间短、透视次数少的优点。

Abstract:

Objective To analyze the efficacy and safety of percutaneous transforaminal endoscopic discectomy with trepan in the treatment of L5-S1 disc herniation.Methods The 80 patients with L5-S1 disc herniation admitted to Bozhou People's Hospital from January 2020 to December 2021 were selected, and they were divided into study group and control group by the random number table method, with 40 cases in each group. Both groups were treated with percutaneous transforaminal endoscopic discectomy. The study group was treated with trepans, while the control group was treated with bone drills. All the patients were followed up for 6 months after the surgery. The operation-associated conditions, pain and lumbar dysfunction, as well as the surgical outcome, imaging findings of the affected segments and postoperative complications were compared between the two groups.Results Compared with the control group, the duration of approach establishment and that of operation were shorter, the time of fluoroscopy was fewer, and the amount of bone removal of the superior articular process was higher in the study group (P < 0.05). There was no significant difference in the duration of endoscopic operation and intraoperative blood loss between the two groups (P> 0.05). The Visual Analogue Scale (VAS) scores before and 7 days, 1 month and 3 months after the operation in the two groups were compared via repeated measures analysis of variance, and the results exhibited that the VAS scores were different among the time points, and those after the operation were all lower than those before the operation (P < 0.05). There was no difference in VAS scores or the change trends of VAS scores between the two groups (P > 0.05). The Japanese Orthopaedic Association (JOA) scores and Oswestry Disability Index (ODI) scores before and 1 month, 3 months and 6 months after the operation were compared via repeated measures analysis of variance. The JOA and ODI scores were demonstrated to be different among the time points, where JOA scores after the operation were all higher than those before the operation while ODI scores after the operation were all lower than those before the operation (P < 0.05). There was no difference in the JOA and ODI scores and the change trends thereof between the two groups (P > 0.05). The overall good and excellent therapeutic efficacy rates were not different between the two groups (P> 0.05). The horizontal dislocation and angular dislocation before and 1 month, 3 months and 6 months after the operation were also compared via repeated measures analysis of variance, the results revealed that the horizontal dislocation and angular dislocation were not different among the time points and between the two groups (P > 0.05), and that the change trends of the horizontal dislocation and angular dislocation were not different between the two groups (P > 0.05). There was no difference in the overall incidence of complications between the two groups (P > 0.05).Conclusions Percutaneous transforaminal endoscopic discectomy with trepan is safe and effective for the treatment of L₅-S₁ disc herniation, and has the advantages of shorter durations of approach establishment and operation and fewer times of fluoroscopy.