两种手术治疗腰椎融合术后邻近节段椎间盘突出症的疗效比较  

Comparison of two kinds of surgeries for treatment of adjacent-level disc herniation after lumbar fusion

作　　者：李鹏[1] 高利峰[1] 胡军华[1] 刘雅普[1] 王松茂[1] 徐永辉[1] 侯秀伟[1] 吴广良[1] LI Peng;GAO Li-feng;HU Jun-hua;LIU Ya-pu;WANG Song-mao;XU Yong-hui;HOU Xiu-wei;WU Guang-liang(Dept of Spinal Surgery, the Second Affiliated Hospital of Luohe Medical College, Luohe,Henan 462300,China)

机构地区：[1]漯河医学高等专科学校第二附属医院脊柱外科,河南漯河462300

出　　处：《临床骨科杂志》2021年第3期326-330,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较经皮椎间孔镜和单纯开窗髓核摘除术治疗腰椎融合术后邻近节段椎间盘突出症的疗效。方法将43例腰椎融合术后邻近节段椎间盘突出症患者按治疗方法不同分为椎间孔镜组(26例,采用经皮椎间孔镜髓核摘除术)和开窗组(17例,采用单纯开窗髓核摘除术)。记录两组手术情况,比较两组术后腰腿痛VAS评分及ODI。结果患者均获得随访,时间6~12个月。手术时间椎间孔镜组长于开窗组(P<0.05),术中出血量、术后首次下床活动时间、住院时间椎间孔镜组少(短)于开窗组(P<0.05)。腰腿痛VAS评分:术后1 d及1、3、6个月均较术前明显改善(P<0.05),术后各时间点两组间比较差异均无统计学意义(P>0.05)。ODI:术后1、6个月均较术前明显改善(P<0.05);术后各时间点两组间比较差异均无统计学意义(P>0.05)。结论与单纯开窗髓核摘除术相比,经皮椎间孔镜髓核摘除术治疗腰椎融合术后邻近节段椎间盘突出症同样可以取得满意的疗效,而且术中出血少、下床活动早、住院时间短,但手术时间长。Objective To compare the efficacy of percutaneous transforaminal endoscopic discectomy and simple fenestration discectomy of nucleus pulposus in the treatment of adjacent segement disc herniation after lumbar fusion.Methods The 43 patients who suffered from adjacent segement disc herniation after lumbar instrumentation fusion were divided into transforaminal endoscopic group(26 cases were adopted with percutaneous endoscopic nucleus pulposus discectomy)and fenestration group(17 patients were performed with fenestration nucleus pulposus discectomy).The operation situation of the two groups were recorded,the VAS of lumbocrural pain and ODI were compared between the two groups.Results All patients were followed up for 6~12 months.The operation time of transforaminal endoscopy group was longer than that of fenestration group(P<0.05),intraoperative blood loss,postoperative first ambulation time and hospital stay in the transforaminal endoscopy group were less(shorter)than those in the fenestration group(P<0.05).The VAS of lumbocrural pain at 1 d,1,3 and 6 months after operation were significantly improved,compared with those before operation(P<0.05).ODI:at 1,6 months after operation,which were significantly improved than the preoperation(P<0.05).At various time-point postoperation,there were no significant differences for VAS and ODI scores between two groups(P>0.05).Conclusions Compared with the simple fenestration nucleus pulposus discectomy,percutaneous transforaminal endoscopic discectomy can also achieve satisfactory efficacy in the treatment of adjacent segment disc herniation after lumbar fusion,with the advantages of less blood loss,early ambulation,short hospital stay,while which has longer operation time.

关 键 词：腰椎融合术 椎间孔镜 开窗髓核摘除术 邻近节段 椎间盘突出症 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]