两种可视化关节突成型技术治疗L_(5)-S_(1)椎间盘突出症:临床结局半年随访评价  

Two visual arthroplasty techniques for L_(5)-S_(1) disc herniation:a half-year follow-up evaluation of clinical outcomes

作　　者：鹿麒 孙玛骥 王学志 宋婷 马一鸣 袁峰 陈宏亮 Lu Qi;Sun Maji;Wang Xuezhi;Song Ting;Ma Yiming;Yuan Feng;Chen Hongiang(Department of Spinal Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221006,Jiangsu Province,China;First Clinical Medical College of Xuzhou Medical University,Xuzhou 221001,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院脊柱外科,江苏省徐州市221006 [2]徐州医科大学第一临床医学院,江苏省徐州市221001

出　　处：《中国组织工程研究》2025年第9期1841-1847,共7页Chinese Journal of Tissue Engineering Research

基　　金：江苏省卫生健康委员会项目(Z2021070),项目负责人:陈宏亮。

摘　　要：背景:目前脊柱内镜技术已经成为微创脊柱外科的主流技术,不同操作系统的器械规格不同,具体手术方案的选择需要结合患者的实际情况和临床手术医师的选择。目的:比较iLESSYSDelta系统与Endo-SurgiPlus系统下经椎板间入路髓核摘除治疗L_(5)-S_(1)椎间盘突出症的早期效果。方法:纳入80例经椎板间入路髓核摘除治疗的L_(5)-S_(1)段椎间盘突出症患者,根据采用的内镜系统分为2组,其中37例使用了iLESSYS Delta手术系统(Delta组),43例使用了Endo-Surgi Plus手术系统(Plus组)。对两组患者的人口统计学资料、围术期指标和并发症进行分析。在术后1 d及1,3,6个月随访时间点,使用背部和腿部疼痛目测类比评分、Oswestry功能障碍指数和日本骨科协会评分对临床疗效进行量化,并根据改良后MacNab标准在末次随访时对患者满意度进行评估。结果与结论:①Plus组患者的手术时间和关节突成型次数少于Delta组,差异有显著性意义(P<0.05);②与术前相比,两组患者在所有随访时间点的目测类比评分、Oswestry功能障碍指数和日本骨科协会评分均有所改善,差异有显著性意义(P<0.001);③在术后相同时间点,两组患者的目测类比评分、Oswestry功能障碍指数和日本骨科协会评分比较差异均无显著性意义(P>0.05);④术后6个月随访时,Delta组及Plus组的MacNab标准优良率分别为81%和79%,差异无显著性意义(P=0.823);⑤Delta组并发症发生率为3%,Plus组并发症发生率为2%,但两组之间差异无显著性意义(P=0.914);⑥提示iLESSYS Delta和Endo-Surgi Plus手术系统在治疗腰椎间盘突出症方面都取得了令人满意的早期疗效,其中Endo-SurgiPlus手术成型效率更高,安全性更高。BACKGROUND:Currently,spinal endoscopic technology has become the mainstream technology in minimally invasive spinal surgery.The specifications of the instruments for different operating systems are different,and the choice of specific surgical protocols needs to be combined with the actual situation of the patient and the choice of the clinical surgeon.OBJECTIVE:To compare the early efficacy of percutaneous endoscopic interlaminar discectomy for L_(5)-S_(1) disc herniation under the iLESSYS Delta System and Endo-Surgi Plus System.METHODS:Totally 80 patients with L_(5)-S_(1) disc herniation were treated with percutaneous endoscopic interlaminar discectomy.Patients were divided into two groups based on the endoscopic system used.Among them,37 cases received the iLESSYS Delta System(Delta group)and 43 cases received the Endo-Surgi Plus System(Plus group).Patient demographic characteristics,perioperative indicators,and complications were analyzed between the two groups.Clinical outcomes were quantified using back and leg visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores at 1 day,1,3,and 6 months after surgery.Patient satisfaction was assessed according to modified MacNab criteria at final follow-up.RESULTS AND CONCLUSION:(1)The operative time and number of arthroplasties in the Plus group were less than those in the Delta group,and the differences were statistically significant(P<0.05).(2)Compared with the preoperative period,the visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in both groups improved at all follow-up time points,and the difference was statistically significant(P<0.001).(3)There was no statistically significant difference in the comparison of pain visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in the two groups(P>0.05).(4)At 6-month follow-up after surgery,the MacNab standard excellent and good rates in the Delta group and Plus group

关 键 词：微创技术 腰椎间盘突出症 经椎板间入路 髓核摘除 iLESSYSDelta EndoSurgiPlus 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R619