经皮椎间孔镜技术治疗腰椎融合术后相邻节段椎间盘突出症  

Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Adjacent Segment Disc Herniation After Lumbar Fusion

作　　者：朱剑 镐英杰[1] 任志楠 朱广铎 于磊[1] 张盼可 曹书严 宋鑫 Zhu Jian;Hao Yingjie;Ren Zhinan(Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450000

出　　处：《中国微创外科杂志》2022年第3期222-227,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：河南省医学科技攻关计划省部共建项目(SB201903001)。

摘　　要：目的探讨经皮椎间孔镜技术治疗腰椎融合术后相邻节段椎间盘突出症的疗效。方法回顾性分析2015年8月~2019年8月66例腰椎融合术后相邻节段椎间盘突出症资料,根据患者意愿行椎间孔镜30例,开放后路手术36例。比较2组手术时间、出血量、术后住院时间,术前、术后1周、术后3个月、术后1年采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、日本骨科协会(Japanese Orthopedic Association,JOA)评分进行评估。结果与开放组相比,椎间孔镜组手术时间短[(65.8±6.4)min vs.(126.1±7.6)min,t=-34.463,P=0.000],出血少[(29.4±9.1)ml vs.(294.4±31.2)ml,t=-48.633,P=0.000],术后住院时间短[(5.9±1.6)d vs.(11.2±2.4)d,t=-10.511,P=0.000],腰痛和腿痛VAS评分、JOA评分改善更多(P<0.05),术后1年疗效(JOA改善率)更优(Z=-3.349,P=0.001)。结论在严格把握椎间孔镜技术适应证的前提下,经皮椎间孔镜技术治疗腰椎融合术后相邻节段椎间盘突出症较常规后路开放手术具有手术时间短、出血少、住院时间短、恢复快的优点。Objective To explore the efficacy of percutaneous endoscopic lumbar discectomy(PELD)in the treatment of adjacent segment disc herniation after lumbar spine fusion.Methods A retrospective analysis was made on data of 66 cases of adjacent segment disc herniation from August 2015 to August 2019.According to patients’wishes,there were 30 cases of PELD and 36 cases of posterior lumbar interbody fusion(PLIF).The two groups were compared in terms of operative time,intraoperative bleeding,and postoperative hospital stay.The efficacy of the two groups was assessed by using the Visual Analogue Scale(VAS)and Japanese Orthopedic Association(JOA)scores for pain before surgery,1 week after surgery,3 months after surgery,and 1 year after surgery.Results Compared with the PLIF group,the PELD group had a shorter operative time[(65.8±6.4)min vs.(126.1±7.6)min,t=-34.463,P=0.000],less bleeding[(29.4±9.1)ml vs.(294.4±31.2)ml,t=-48.633,P=0.000],shorter postoperative hospital stay[(5.9±1.6)d vs.(11.2±2.4)d,t=-10.511,P=0.000],more improvement in VAS scores and JOA scores for low back pain and leg pain(P<0.05).And the JOA improvement rate was better 1 year after surgery(Z=-3.349,P=0.001).Conclusion Based on the premise of strictly grasping the indications for intervertebral foraminoscopic technology,PELD for the treatment of adjacent segment disc herniation has advantages of shorter operative time,less bleeding,shorter hospital stay and faster recovery than PLIF.

关 键 词：经皮内镜腰椎间盘切除术 腰椎间盘突出症 邻椎病 

分 类 号：R68[医药卫生—骨科学]