经椎板间入路与椎间孔入路脊柱内镜减压术治疗L_(5)-S_(1)节段钙化型腰椎间盘突出症的疗效分析  

Efficacy analysis of spinal endoscopic decompression through interlaminar and foraminal approaches for L_(5)-S_(1) segment calcified lumbar disc herniation

作　　者：林亮[1] 陈彦平[1] 赵冲 李长宽 LIN Liang;CHEN Yan-ping;ZHAO Chong;LI Chang-kuan(Department of Spinal and Spinal Surgery,Cangzhou Integrated Traditional Chinese and Western Medicine Hospital,Cangzhou,Hebei 061000,China)

机构地区：[1]河北省沧州中西医结合医院脊柱脊髓外二科,河北沧州061000

出　　处：《颈腰痛杂志》2024年第2期330-334,385,共6页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的对比分析经椎间孔入路和椎板间入路行脊柱内镜减压术治疗L_(5)-S_(1)节段钙化型腰椎间盘突出症(calcified lumbar disc herniation,CLDH)的疗效。方法回顾性分析该科2019年1月~2022年1月采用脊柱内镜手术治疗的67例L_(5)-S_(1)节段CLDH患者资料,按照手术方法分组:采用椎板间入路经皮内镜下椎间盘切除术(percutaneous endoscopic interlaminar discectomy,PEID)34例,纳入PEID组;采用经皮椎间孔入路经皮内镜下椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗33例,纳入PETD组。统计两组患者的临床资料、手术情况和术后疗效指标,并进行分组比较。结果两组患者的性别、年龄、病程、BMI、钙化类型、术后随访时间等临床资料差异均无统计学意义(P>0.05)。与PETD组相比,PEID组的手术时间显著缩短,X线透视次数显著减少(P<0.05);两组患者的术后住院时间差异无统计学意义(P>0.05)。与术前相比,两组患者术后1 d、3个月和1年的VAS评分和ODI评分均显著降低(P<0.05),但组间差异均无统计学意义(P>0.05)。末次随访时,PEID组的优良率为91.2%,PETD组为87.9%,差异无统计学意义(P>0.05)。并发症方面,PETD组术后有1例出现下肢感觉异常,1例有残留的突出髓核组织未取净;PEID组有2例术后出现下肢感觉异常,1例出现硬膜撕裂但未出现脑脊液漏。两组并发症差异无统计学意义(P>0.05)。结论PEID和PETD治疗CLDH均可取得满意的减压效果,前者手术时间短、X线透视少;后者可在局部麻醉下开展,避免了全麻所致的麻醉风险。Objective To compare and analyze the efficacy of endoscopic spinal decompression through the intervertebral foramen approach and the interlaminar approach in the treatment of L_(5)-S_(1) segment calcified lumbar disc herniation(CLDH).Methods A retrospective analysis was conducted on the data of 67 patients with L_(5)-S_(1) segment CLDH who underwent spinal endoscopic surgery in our department from January 2019 to January 2022.They were divided into four groups according to different surgical methods:34 patients underwent percutaneous endoscopic interlaminar discectomy(PEID)through the intervertebral disc approach and were included in the PEID group;33 cases were treated with percutaneous endoscopic transforaminal discectomy(PETD)through a percutaneous foramen approach and included in the PETD group.The clinical data,surgical conditions,and postoperative efficacy indicators of patients were collected and compared between the two groups.Results There was no statistically significant difference in clinical data such as gender,age,course of disease,BMI,type of calcification,and postoperative follow-up time between the two groups(P>0.05).Compared with the PETD group,the surgical time and X-ray fluoroscopy frequency of the PEID group were significantly shortened(P<0.05);there was no statistically significant difference in postoperative hospitalization time between the two groups(P>0.05).Compared with preoperative,the VAS score and ODI score of the two groups were significantly reduced on the first day,three months,and one year after surgery(P<0.05),but there was no statistically significant difference between the groups(P>0.05).At the last follow-up,the improved MacNab standard was used to evaluate the efficacy:the excellent and good rate in the PEID group was 91.2%,while in the PETD group it was 87.9%,with no statistically significant difference(P>0.05).In terms of complications,one patient in the PETD group experienced lower limb sensory abnormalities after surgery,and one patient had residual protruding nucleus pulp

关 键 词：钙化型腰椎间盘突出症 脊柱内镜 经椎间孔入路 经椎板间入路 L_(5)-S_(1)节段 

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