脊柱内镜与椎间融合治疗腰椎间盘突出症伴终板骨软骨炎的疗效对比  

Comparison of Spinal Endoscopic Surgery and Lumbar Interbody Fusion in Treatment of Lumbar Intervertebral Disc Herniation Associated with End-plate Osteochondritis

作　　者：邓亦奇 孙付杰[1] 汪明星[1] 时广力 邹士东 Deng Yiqi;Sun Fujie;Wang Mingxing(Department of Orthopaedics,Central Hospital of Shanxian,Heze 274300,Chin)

机构地区：[1]单县中心医院骨科,山东菏泽274300

出　　处：《实用骨科杂志》2018年第8期677-681,共5页Journal of Practical Orthopaedics

基　　金：山东省医药卫生科技发展计划项目(2017WS480)

摘　　要：目的探讨脊柱内镜与椎间融合修复在治疗腰椎间盘突出症伴终板骨软骨炎中的临床疗效对比。方法对2015年3月至2017年2月期间在我院手术治疗且随访时间≥1年的腰椎间盘突出症伴终板骨软骨炎116例患者进行回顾性分析,其中男66例,女50例;年龄为33~69岁,平均年龄42.7岁。均为单节段,按手术方法不同分为两组,采用经皮椎间孔镜手术治疗55例(男35例,女20例),累及L3~4节段3例,L4~5节段27例,L5S1节段25例,在其临床症状较重一侧进行经皮椎间孔镜下神经减压、髓核摘除术;采取椎间融合修复手术患者61例(男31例,女30例),累及L3~4节段5例,L4~5节段29例,L5S1节段27例,在责任椎间节段行椎板减压,切除椎间盘组织,植骨融合椎间关节,提供坚强椎弓根螺钉固定。比较两组手术时间、手术切口长度、手术出血量及住院时间,随访时观察疗效及视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI),根据改良MacNab疗效评定标准评估优良率。结果两组患者均顺利完成治疗,随访12~24个月,平均17.8个月。脊柱内镜组手术时间、手术切口长度、手术出血量及住院时间均优于椎间融合组,比较差异有统计学意义(P<0.05)。两组术后首次、术后6个月及末次随访VAS、ODI评分均降低,与治疗前比较差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。脊柱内镜组优良率为92.7%(51/55),椎间融合组优良率88.5%(54/61),两组比较差异无统计学意义(P>0.05)。结论脊柱内镜同椎间融合修复在治疗腰椎间盘突出症伴终板骨软骨炎中均可获得良好的疗效,且疗效无差异,但脊柱内镜手术创伤小,住院治疗和恢复时间短。Objective To compare the effects of spinal endoscopy and lumbar interbody fusion in treatment of lumbar intervertebral disc herniation associated with end-plate osteochondritis.Methods A retrospective analysis was performed on 116 cases of patients with lumbar intervertebral disc herniation associated with end-plate osteochondritis.They underwent surgery in our department from March 2015 to February 2017 and were followed up for more than 1 year.The patients had an average age of 42.7 years old（range from 33 to 69 years old）.According to the treatment,they were divided into two groups.27 cases were treated with percutaneous intervertebral endoscopic surgery（35 males and20 females）.There were 3 cases of L3-4,27 cases of L4-5 and 25 cases of L5 S1.Removal of herniated nucleus pulposus and nerve root decompression and release were performed on the side with severe clinical symptoms.Another 61 cases（31 cases were males and 30 were females）were treated with interbody fusion surgery,including L3-4 in 5 cases,L4-5 in 29 cases and L5 S1 in 27 cases.Laminar decompression was performed on the responsible intervertebral segment to remove the intervertebral disc tissue,and interbody fusion with bone graft to provide a firm pedicle screw fixation.The operation time,length of surgical incision,volume of blood loss,length of stay were compared between two groups.During the follow-up,the Visual analogue scale（VAS）and Oswestry disability index（ODI）were observed.Excellent rate was evaluated according to the MacNab criteria.Results All patients were received successful treatment and followed up with a mean follow-up of 17.8 months（range 12 to 24 months）.The operation time,length of surgical incision,volume of blood loss,length of stay in spinal endoscopy group were better than those in lumbar interbody fusion group（P〈0.05）.Compared with pre-operation,the VAS and ODI scores were decreased in the first,6 th month,and final followup after operation in two groups（P〈0.05）.However,no significant differ

关 键 词：腰椎间盘突出 椎体终板骨软骨炎 腰椎融合术 内窥镜检查 

分 类 号：R681.53[医药卫生—骨科学]