内镜与通道经椎板切除青年巨大L_(5)S_(1)椎间盘突出  

Endoscopic translaminar discectomy versus channel counterpart for large L_(5)S_(1)disc herniation in young adults

作　　者：徐世民[1] 李志卫 于明东[1] 孙良智[1] 刘伟强[1] 李曰众 张峻山[1] 高加智[2] XU Shi-min;LI Zhi-wei;YU Ming-dong;SUN Liang-zhi;LIU Wei-qiang;LI Yue-zhong;ZHANG Jun-shan;GAO Jia-zhi(Department of Spinal Surgery,People's Hospital of Weifang City,Weifang 261041,China;Department of Traumatic Orthopedics,People's Hospital of Weifang City,Weifang 261041,China)

机构地区：[1]潍坊市人民医院脊柱外科,山东潍坊261041 [2]潍坊市人民医院创伤骨科,山东潍坊261041

出　　处：《中国矫形外科杂志》2023年第10期870-875,共6页Orthopedic Journal of China

摘　　要：[目的]比较Delta内镜与Quadrant通道经椎板间入路椎间盘切除治疗青年巨大L_(5)S_(1)腰椎间盘突出症的临床效果。[方法]回顾性分析2018年1月—2020年12月在本科微创手术治疗62例巨大L_(5)S_(1)腰椎间盘突出症的青年患者的临床资料。依据术前医患沟通结果,27例采用内镜椎间盘切除术,35例采用经通道椎间盘切除术。比较两组患者围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,均无严重并发症。虽然内镜组手术时间显著长于通道组[(123.1±13.7)min vs(112.1±13.3),P=0.002],但是,内镜组术中失血量[(15.6±3.1)ml vs(38.1±6.2)ml,P<0.001]、切口总长度[(1.1±0.3)cm vs(2.3±0.4)cm,P<0.001]、下地行走时间[(1.5±0.9)d vs(2.5±1.4)d,P<0.001]、住院时间[(6.1±1.4)d vs(8.4±1.7)d,P<0.001]均显著优于通道组。所有患者均获随访12~36个月,平均(24.1±5.2)个月,内镜组恢复完全负重时间显著早于通道组[(88.2±1.2)d vs(90.2±1.4)d,P<0.001]。随时间推移,两组腰痛和腿痛VAS以及ODI评分均显著降低(P<0.05);术前两组间VAS和ODI评分的差异无统计学意义(P>0.05),出院时内镜组的腰痛VAS评分[(3.0±0.9)vs(3.3±1.0),P=0.028]、腿痛VAS评分[(3.0±0.8)vs(3.5±0.9),P=0.032]和ODI评分[(20.7±4.0)vs(23.0±3.5),P=0.019]均显著优于通道组,但是末次随访时两组间上述评分的差异已无统计学意义(P>0.05)。影像方面,随时间推移,两组椎间隙高度和腰椎前凸角(L_(5)S_(1)Cobb角)均无明显改变(P>0.05);但两组术后椎管面积较术前显著扩大(P<0.05)。相应时间点,两组间椎间隙高度、椎管面积和腰椎前凸角的差异均无统计学意义(P>0.05)[结论]对于治疗青年巨大腰椎间盘突出症,Delta内镜椎间盘切除术相较于Quadrant通道术式创伤更小,更有利于早期恢复。[Objective]To compare the clinical outcomes of percutaneous endoscopic interlaminar discectomy(PEID)with the Delta en-doscopy versus the counterpart through the Quadrant channel for large L_(5)S_(1)disc herniation in young adults.[Methods]A retrospective study was performed on 62 young patients who underwent minimally invasive surgery for the giant L_(5)S_(1)disc herniation in our department from Janu-ary 2018 to December 2020.According to the results of preoperative doctor-patient communication,27 patients received the endoscopic discectomy(ED),while the other 35 patients underwent the channel discectomy(CD).The perioperative period,follow-up and imaging data of the two groups were compared.[Results]All the patients in both groups had operation performed successfully without serious complications.Although the ED group consumed significantly longer operative time than the CD group[(123.1±13.7)min vs(112.1±13.3),P=0.002],the former proved significantly superior to the latter in terms of intraoperative blood loss[(15.6±3.1)ml vs(38.1±6.2)ml,P<0.001],total incision length[(1.1±0.3)cm vs(2.3±0.4)cm,P<0.001],postoperative walking time[(1.5±0.9)days vs(2.5±1.4)days,P<0.001]and hospital stay[(6.1±1.4)days vs(8.4±1.7)days,P<0.001].All of them were followed up for 12 to 36 months,with a mean of(24.08±5.17)months,the patients in the ED group resumed full weight-bearing activity significantly earlier than those in the CD group[(88.2±1.2)days vs(90.2±1.4)days,P<0.001].The VAS scores for lumbago and leg pain,as well as ODI scores significantly decreased over time in both groups(P<0.05).The VAS and ODI scores were not statistically significant between the two groups preoperatively(P>0.05).The ED group was significantly superior to the CD group in terms of VAS score for low back pain[(3.0±0.9)vs(3.3±1.0),P=0.028],VAS score for leg pain[(3.0±0.8)vs(3.5±0.9),P=0.032]and ODI score[(20.7±4.0)vs(23.0±3.5),P=0.019]at discharge from hospital,whereas which became not statistically significant be-tween the two groups

关 键 词：青年人 巨大L_(5)S_(1)椎间盘突出症 Delta内镜 QUADRANT通道 椎间盘切除术 

分 类 号：R681.57[医药卫生—骨科学]