摘要
目的探讨椎间孔镜髓核摘除术治疗巨大型腰椎间盘突出时,采用不同手术入路对术后疗效的影响。方法回顾分析2010年10月-2015年2月因巨大型腰椎间盘突出行椎间孔镜髓核摘除术治疗且获完整随访的122例患者临床资料。根据手术入路方式患者分为4组:A组31例,采用经典椎间孔入路(transforaminal endoscopic spine system,TESSYS);B组30例,采用后外侧入路(Yeung endoscopic spine system,YESS);C组31例,采用改良椎间孔入路(improved transforaminal endoscopic access,ITEA);D组30例,采用椎板间入路(interlaminar dorsal access,IDA)。各组患者性别、年龄、病程、病变节段及术前下腰痛疼痛视觉模拟评分(VAS)、双下肢VAS评分、Oswestry功能障碍指数(ODI)、椎间隙高度、腰椎曲度指数(lumbar curvature index,LCI)及椎间盘退变程度分级等一般资料比较,差异均无统计学意义(P>0.05)。比较各组术中髓核摘除体积,术后VAS评分、ODI评分、LCI、椎间隙高度和椎间盘退变程度分级。结果A、B、C、D组术中髓核摘除体积分别为(3.6±0.9)、(3.5±0.7)、(4.6±1.0)、(3.1±1.1)cm3,组间比较差异均有统计学意义(P<0.05)。术后患者切口均Ⅰ期愈合,无术后早期并发症发生。所有患者均获随访,随访时间12~35个月,平均24个月。随访期间无典型术后髓核突出复发症状,无椎间隙感染、脑脊液漏、硬膜外血肿等并发症发生。末次随访时,各组下腰痛VAS评分、双下肢VAS评分、ODI评分均较术前显著改善(P<0.05);术后各组间各评分以及改善值比较,差异均无统计学意义(P>0.05)。末次随访时,B组椎间盘退变程度分级较术前显著改善(P<0.05);4组间椎间盘退变程度分级比较,差异无统计学意义(P>0.05)。末次随访时,各组LCI与术前比较差异均无统计学意义(P>0.05);4组间LCI以及丢失值比较,差异亦无统计学意义(P>0.05)。各组术后即刻及末次随访时椎间隙高度与术前比较,差异无统计学意义(P>0.05);4组术后即刻及末次随访时椎间隙高度比较、末次随访时椎间隙高度变化比较,差异均无统计学意义(P>0.05)。结论椎间孔镜髓核摘除术治疗巨大型腰椎间盘突出效果良好,其中采用ITEA手术操作范围更大,术中探查及摘除责任髓核更彻底;但需要根据患者腰椎间盘突出特点选择合适的手术入路。
Objective To investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation.Methods Between October 2010 and February 2015,a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope.The patients were divided into 4 groups according to the different approaches.The transforaminal endoscopic spine system(TESSYS)technology was used in group A(31 cases),Yeung endoscopic spine system(YESS)technology was used in group B(30 cases),improved transforaminal endoscopic access(ITEA)technology was used in group C(31 cases),and interlaminar dorsal access(IDA)technology was used in group D(30 cases).There was no significant difference in gender,age,disease duration,lesion segment,and preoperative visual analogue scale(VAS)score of low back pain,VAS score of bilateral lower extremities pain,Oswestry disability index(ODI),intervertebral height,lumbar curvature index(LCI),and disc degeneration grading between groups(P>0.05).The removal volume of nucleus pulposus was compared;after operation,VAS score,ODI score,LCI,intervertebral height,and disc degeneration grading were used to evaluate the effectiveness.Results The removal volumes of nucleus pulposus in groups A,B,C,and D were(3.6±0.9),(3.5±0.7),(4.6±1.0),(3.1±1.1)cm3,respectively.There were significant differences between groups(P<0.05).All incisions healed by first intention,and no early postoperative complications was found.All cases were followed up 12-35 months,with an average of 24 months.During follow-up,there was no recurrence of nucleus pulposus herniation,infection of intervertebral space,cerebrospinal fluid leakage,epidural hematoma,or other complications.At last follow-up,the VAS scores of low back pain and bilateral lower extremities pain,and ODI scores in each group significantly improved when compared with those before operation(P<0.05);there was no significant difference in the scores and improvements between groups after operation(P>0.05).At last follow-up,the disc degeneration grading in group B significantly improved when compared with that before operation(P<0.05);there was no significant difference between groups(P>0.05).At last follow-up,there was no significant difference in LCI of each group when compared with that before operation(P>0.05);and there was no significant difference in LCI and loss value between groups(P>0.05).There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value(P>0.05),and there was no significant difference between groups at immediate after operation and last follow-up(P>0.05).Conclusion Application of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes.The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus.However,the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.
作者
杨虎
李鹏飞
贾楠
王金星
靳宪辉
YANG Hu;LI Pengfei;JIA Nan;WANG Jinxing;JIN Xianhui(Department of Orthopaedics,Harrison International Peace Hospital,Hebei Medical University,Hengshui Hebei,053000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第3期300-307,共8页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
髓核摘除术
椎间孔镜
微创手术
巨大型腰椎间盘突出
手术入路
Discectomy
transforaminal endoscope
minimally invasive surgery
serious lumbar disc herniation
approach
