后路经椎板间内镜与显微镜辅助髓核切除术治疗复发性腰椎间盘突出症  

Comparison of clinical outcomes and complications between translaminar endoscopic lumbar discectomy and microdiscectomy in the treatment of recurrent lumbar disc herniation

作　　者：张心之 杨欣雨 原所茂[1] 王连雷 田永昊[1] 刘新宇[1] Zhang Xinzhi;Yang Xinyu;Yuan Suomao;Wang Lianlei;Tian Yonghao;Liu Xinyu(Department of Orthopaedics,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院骨科,济南250012

出　　处：《中华骨科杂志》2025年第1期1-9,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81874022,82172483,82102522);山东泰山学者项目(tsqn202211317,tstp20231247);山东省重点项目(2022CXGC010503,2022ZLGX03);山东省自然科学基金(ZR202102210113)。

摘　　要：目的比较腰椎后路经椎板间内镜辅助髓核切除术(percutaneous endoscopic interlaminar discectomy,PEID)和后路小切口显微镜辅助髓核切除术(microdiscectomy,MD)治疗复发性腰椎间盘突出症的临床疗效。方法回顾性分析2012年7月至2022年8月于山东大学齐鲁医院因腰椎间盘突出症同节段复发而再次接受手术治疗的132例患者资料,分别采用PEID或MD进行翻修。PEID组90例,男51例、女39例,年龄(42.7±11.3)岁,体质指数(23.7±3.4)kg/m^(2),手术节段:L_(4-5)38例、L_(5)S_(1)52例,初次手术:切开手术7例、椎板截骨回植3例、MD 35例、PEID 45例。MD组42例,男30例、女12例,年龄(41.2±12.6)岁,体质指数(24.3±4.7)kg/m^(2),手术节段:L_(4-5)19例、L_(5)S_(1)23例,初次手术:切开手术2例、椎板截骨回植1例、MD 17例、PEID 22例。比较PEID组和MD组手术前后腰痛和下肢痛的视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及术后即刻手术切口VAS、术中出血量、手术切口长度、手术时间、住院时间以及并发症发生率。结果PEID组手术时间为(81.7±11.3)min,MD组为(85.2±9.5)min,差异无统计学意义(t=1.740,P=0.081)。PEID组术中出血量为(4.4±2.9)ml、手术切口长度为(0.9±0.2)cm、住院时间为(3.1±1.3)d,均著小于MD组的(26.6±10.3)ml、(3.4±1.1)cm、(8.7±1.6)d,差异有统计学意义(P<0.05)。PEID组的随访时间为(24.4±5.5)个月,MD组为(24.5±4.9)个月,两组比较差异无统计学意义(t=0.101,P=0.920)。两组术后下肢痛VAS评分、腰痛VAS评分及ODI均较术前明显改善(P<0.05);PEID组术后第1天手术切口VAS评分为(1.2±0.4)分,低于MD组的(2.9±0.6)分,差异有统计学意义(t=19.261,P<0.001)。术后PEID组肌力下降、术后感觉异常和硬脊膜撕裂的发生率分别为12%(11/90)、27%(24/90)和6%(5/90),低于MD组的31%(13/42)、40%(17/42)和33%(14/42),差异均有统计学意义(P<0.05);两组再复发、髓核残留、类脊髓Objective To compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy(PEID)and posterior small incision microdiscectomy(MD)in the treatment of recurrent lumbar disc herniation.Methods A retrospective analysis was conducted on the data of 132 patients who underwent revision surgery for recurrent lumbar disc herniation at the same segment at Qilu Hospital of Shandong University between July 2012 and August 2022.The patients were treated with either PEID or MD.The PEID group consisted of 90 patients,including 51 males and 39 females,with a mean age of 42.7±11.3 years and a mean body mass index(BMI)of 23.7±3.4 kg/m^(2).The surgical segments were L_(4-5)in 38 cases and L_(5)S_(1)in 52 cases.The primary surgeries included open discectomy in 7 cases,laminectomy with bone graft in 3 cases,MD in 35 cases,and PEID in 45 cases.The MD group consisted of 42 patients,including 30 males and 12 females,with a mean age of 41.2±12.6 years and a mean BMI of 24.3±4.7 kg/m^(2).The surgical segments were L_(4-5)in 19 cases and L_(5)S_(1)in 23 cases.The primary surgeries included open discectomy in 2 cases,laminectomy with bone graft in 1 case,MD in 17 cases,and PEID in 22 cases.The visual analogue scale(VAS)scores for low back pain and leg pain,Oswestry disability index(ODI),immediate postoperative VAS score for surgical wound pain,intraoperative blood loss,surgical wound length,operation duration,length of hospital stay,and various complications before and after surgery were compared between the PEID and MD groups.Results The operation duration in the PEID group was 81.7±11.3 min,that in the MD group was 85.2±9.5 min,but the difference was not statistically significant(t=1.740,P=0.081).The intraoperative blood loss in the PEID group was 4.4±2.9 ml,the surgical wound length was 0.9±0.2 cm,and the length of hospital stay was 3.1±1.3 d,all significantly less than those in the MD group(26.6±10.3 ml,3.4±1.1 cm,and 8.7±1.6 d,respectively),with statistically significant differences(P<0.05).Both groups wer

关 键 词：腰椎 椎间盘移位 髓核 椎间盘切除术 内窥镜检查 

分 类 号：R687.3[医药卫生—骨科学]