椎间孔入路和椎板间入路脊柱内镜手术联合纤维环缝合治疗腰椎间盘突出症的疗效比较  

Efficacy comparison of endoscopic spinal surgery combined with annuals fibrosus repair via the transforaminal and interlaminar approaches in the treatment of lumbar disc herniation

作　　者：雷雨鸣 袁利杰[1] 邹俊[2] 屈路强[1] 顾晓岚 LEI Yuming;YUAN Lijie;ZOU Jun;QU Luqiang;GU Xiaolan(Department of Spinal Surgery,the First People's Hospital of Taicang,Taicang 215400,Jiangsu,China;Department of Spinal Surgery,the First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]太仓市第一人民医院脊柱外科,江苏太仓215400 [2]苏州大学附属第一医院脊柱外科,江苏苏州215006

出　　处：《中华骨与关节外科杂志》2024年第8期699-706,共8页Chinese Journal of Bone and Joint Surgery

基　　金：太仓市科技局医疗卫生关键技术攻关项目(TC2023JCYLD10)。

摘　　要：目的:探讨椎间孔入路和椎板间入路脊柱内镜手术联合纤维环缝合治疗腰椎间盘突出症(LDH)的临床疗效。方法:回顾性分析2018年3月至2022年2月太仓市第一人民医院收治的65例LDH患者的临床资料,根据脊柱内镜手术入路不同,采用椎间孔入路脊柱内镜手术的32例作为椎间孔组,采用椎板间入路脊柱内镜手术的33例作为椎板间组。比较两组患者的围手术期指标,术前和术后3个月时的疼痛情况、腰椎功能、脊髓神经功能,术后3个月的并发症发生情况,随访2年内的复发率。结果:随访时间24~38个月,平均(31.4±5.8)个月。椎板间组患者手术时间、术中接受X线放射次数均少于椎间孔组(P均<0.05);两组患者失血量、住院时间比较,差异均无统计学意义(P均>0.05)。两组患者术后3个月的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)均较术前降低(P均<0.05),但组间比较差异均无统计学意义(P均>0.05)。两组患者术后3个月神经潜伏期均较术前缩短,神经传导速度均较术前增加(P均<0.05),但组间比较差异均无统计学意义(P均>0.05)。两组患者术后3个月并发症总发生率比较,差异无统计学意义(P>0.05)。术后2年随访,两组患者的复发率比较,差异无统计学意义(P>0.05),椎板间组患者的复发时间较椎间孔组延后(P<0.05)。结论:椎间孔入路和椎板间入路脊柱内镜手术联合纤维环缝合治疗LDH在改善疼痛、腰椎功能及脊髓神经功能方面的疗效相当,且手术并发症风险接近。椎板间入路的手术时间更短、术中接受X线放射次数更少,并可延后LDH复发时间。Objective:To explore the clinical efficacy of endoscopic spinal surgery combined with annuals fibrosus repair via the transforaminal and interlaminar approaches in the treatment of lumbar disc herniation(LDH).Methods:A retrospective analysis was conducted on the clinical data of 65 LDH patients admitted to the First People's Hospital of Taicang from March 2018 to February 2022.Patients were divided into two groups on the basis of the different approaches of endoscopic spinal surgery:the transforaminal group(32 cases)and the interlaminar group(33 cases).Perioperative indicators,pain levels,lumbar and spinal nerve functions before and 3 months after surgery,complication rates at the 3 months postoperatively,and recurrence rates within 2 years of follow-up were compared between the two groups.Results:The follow-up duration ranged from 24 to 38 months,with an average of(31.4±5.8)months.The interlaminar group presented a shorter operative time and a reduced X-ray exposure frequency compared to the transforaminal group(all P<0.05).There was no statistically significant difference in terms of blood loss or hospital stay between the two groups(all P>0.05).Both groups showed significant improvement in the Visual Analogue Scale(VAS)for pain and the Oswestry disability index(ODI)at 3 months postoperatively compared to preoperative values(all P<0.05),with no significant difference between the groups(all P>0.05).The two groups showed decreased nerve latency and increased nerve conduction velocity at 3 months postoperatively compared to preoperative levels(all P<0.05),with no significant difference between the groups(all P>0.05).There was no statistically significant difference in the incidence of complications at 3 months after surgery between the two groups(P>0.05).There was no significant difference in 2-year recurrence rates(P>0.05),however,the time to recurrence was delayed in the interlaminar group compared to the transforaminal group(P<0.05).Conclusions:Endoscopic spinal surgery combined with annulus fibrosus repair vi

关 键 词：腰椎间盘突出症 脊柱内镜 纤维环缝合 椎间孔入路 椎板间入路 

分 类 号：R681[医药卫生—骨科学]