硬膜外类固醇激素注射对经皮内窥镜下腰椎椎间盘切除术治疗腰椎椎间盘突出症的疗效及术后复发的影响  

Effects of epidural steroid injection on outcome and recurrence of percutaneous endoscopic lumbar discectomy for lumbar disc herniation

作　　者：武乐成 熊成杰 石长贵 Wu Lecheng;Xiong Chengjie;Shi Changgui(Department of Orthopaedics,Changzheng Hospital,Naval Medical University,Shanghai 200003,China;Department of Orthopaedics,Changde Hospital,Xiangya School of Medicine,Central South University,Changde 415000,Hunan,China)

机构地区：[1]海军军医大学长征医院骨科,上海2000032 [2]中南大学湘雅医学院附属常德医院骨科,常德415000

出　　处：《脊柱外科杂志》2024年第5期302-307,共6页Journal of Spinal Surgery

基　　金：上海市卫生和计划生育委员会科研课题面上项目(201840077);上海市卫生健康委员会科研课题青年项目(20204Y0243)。

摘　　要：目的探讨硬膜外类固醇激素注射(ESI)对经皮内窥镜下腰椎椎间盘切除术(PELD)治疗腰椎椎间盘突出症(LDH)的疗效及术后复发的影响。方法回顾性分析2017年8月—2021年12月海军军医大学长征医院采用PELD治疗的300例LDH患者临床资料,其中2019年10月之前采用PELD治疗的患者154例,术中硬膜外类固醇注射(ESI)1 mL复方倍他米松(ESI组);2019年10月及之后采用PELD治疗的患者146例,术中未行ESI(对照组)。采用疼痛视觉模拟量表(VAS)评分评估下肢疼痛程度,采用Oswestry功能障碍指数(ODI)评估腰椎功能,采用改良MacNab标准评估末次随访时疗效优良率。记录2组患者并发症发生情况及术后复发和再手术情况。结果所有手术顺利完成。2组术后各随访时间点VAS评分和ODI较术前显著降低,术后2周ESI组VAS评分显著低于对照组,差异均有统计学意义(P<0.05)。根据改良MacNab标准,2组疗效优良率差异无统计学意义(P>0.05)。ESI组术前6周内接受ESI治疗的28例患者的复发率(10.7%,3/28)高于其他患者,但差异无统计学意义(P>0.05)。ESI组发生硬膜破裂3例,对照组2例,差异无统计学意义(P>0.05),且均未出现术中马尾疝出和术后脑脊液漏;ESI组发生术后感觉异常3例,对照组10例,差异有统计学意义(P<0.05)。2组患者均未发生术中神经根损伤、术后感染和术后血肿等并发症。随访期间,ESI组9例复发,其中4例再手术;对照组7例复发,其中3例再手术;差异无统计学意义(P>0.05)。结论PELD术中结合ESI治疗有助于缓解术后早期疼痛,降低术后感觉异常发生率;但术前6周内接受过ESI治疗的患者,PELD术中进行ESI存在增加复发风险的可能。Objective To investigate the effect of epidural steroid injection(ESI)on the outcome and recurrence after percutaneous endoscopic lumbar discectomy(PELD)for treatment of lumbar disc herniation(LDH).Methods From August 2017 to December 2021,the data of 300 LDH patients who were treated with PELD in Changzheng Hospital of Naval Medical University were retrospectively analyzed.Among them,154 patients treated with PELD before October 2019 were injected with 1 mL steroid hormone during surgery(ESI group);and 146 patients treated with PELD after October 2019 did not undergo ESI during the surgery(control group).The intensity of lower limb pain was assessed by the visual analogue scale(VAS)score at pre-operation,postoperative 1 month and at the final follow-up;the Oswestry disability index(ODI)was used to assess the lumbar spine function at the final follow-up;and the clinical efficacy was evaluated by the modified MacNab criteria at the final follow-up.The occurrence of complications,postoperative recurrence and reoperation were recorded in the 2 groups.Results All the operations were successfully completed.The VAS scores and ODI in the 2 groups were significantly lower than those before surgery at each follow-up time point,and the VAS score at postoperative 2 weeks in the ESI group was significantly lower than that in control group,all with a statistical significance(P<0.05).According to the modified MacNab criteria,there was no significant difference in the rate of excellent and good therapeutic effect between the 2 groups(P>0.05).The recurrence rate of 28 patients who received ESI treatment within 6 weeks before surgery in the ESI group(10.7%,3/28)was higher than that of other patients,but the difference was not statistically significant(P>0.05).There were 3 cases of dural rupture in the ESI group and 2 in the control group,without statistical significance(P>0.05),and no intraoperative cauda equina hernia or postoperative cerebrospinal fluid leakage.Postoperative paresthesia occurred in 3 cases in the ESI group and

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 外科手术 微创性 糖皮质激素类 注射 硬膜外 

分 类 号：R681.533.1[医药卫生—骨科学]