显微镜辅助Quadrant通道与经皮内镜椎板间入路手术治疗L5/S1椎间盘突出症  

Effect Analysis of microscope-assisted nucleus pulposus removal surgery combined with Quadrant channel technique and percutaneous endoscopic interlamina discectomy for L5/S1 disc herniation

作　　者：张焕 贾川 吴国明 黄盛昌 鄂远 钱志鹏 ZHANG Huan;JIA Chuan;WU Guoming;HUANG Shengchang;E Yuan;QIAN Zhipeng(Department of Orthopedics and Traumatology,Wujin Affiliated Hospital,Nanjing University of Chinese Medi-)

机构地区：[1]南京中医药大学武进附属医院骨伤科,江苏常州213161

出　　处：《中国现代手术学杂志》2024年第6期454-462,共9页Chinese Journal of Modern Operative Surgery

基　　金：江苏省常州市科技计划项目(CJ20230008);江苏省常州市卫生健康委青苗人才培养工程(CZQM2020122)。

摘　　要：目的比较显微镜辅助Quadrant通道与经皮内镜椎板间入路手术(percutaneous endoscopic interlaminar discectomy,PEID)治疗L5/S1腰椎间盘突出症的疗效。方法选择2019年1月至2021年12月行微创手术治疗的单节段(L5/S1)腰椎间盘突出症患者100例,按手术方式分为两组,各50例,分别行显微镜辅助Quadrant通道髓核摘除(M-Q组)与PEID术(PEID组)。记录患者围手术期指标,比较两组患者手术前后腰腿痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI),末次随访时采用改良MacNab标准评价临床效果。结果两组手术均顺利完成。PEID组手术切口小于M-Q组,术后初次下床活动时间早于M-Q组,术后住院时间短于M-Q组(P<0.05),而两组手术时间比较无统计学差异(P>0.05)。术后次日及术后1、3、6、12月两组患者腰腿痛VSA评分及ODI均较术前明显改善(P<0.05);组间比较术后次日及术后1月M-Q组腰腿痛VSA评分及ODI均优于PEID组(P<0.05),至术后3、6、12月两组比较均无统计学差异(P>0.05)。两组患者随访12~24个月,平均(15.48±3.62)个月。末次随访按改良MacNab标准:M-Q组优30例,良18例,可1例,差1例,优良率为96.0%;PEID组优30例,良17例,可2例,差1例,优良率为94.0%;组间优良率比较无统计学差异(P>0.05)。M-Q组出现伤口延迟愈合1例,责任节段复发1例;PEID组出现痛觉过敏和灼样神经根痛3例,术中硬膜囊撕裂1例,责任节段复发2例,术后髓核残留2例;组间比较,M-Q组低于PEID组(P<0.05)。结论显微镜辅助Quadrant通道与PEID治疗L5/S1腰椎间盘突出症均可达到较好的中远期临床效果,但显微镜辅助Quadrant通道技术术后早期疼痛缓解明显,并发症少,视野宽广,适合椎板间隙狭窄需要切除部分椎板彻底减压的患者,而PEID创伤小,患者恢复快,适合椎板间隙宽大、单纯髓核摘除的患者。Objective To compare the efficacy of microscope-assisted nucleus pulposus removal com-bined with Quadrant channel system and percutaneous endoscopic interlaminar discectomy(PEID)in the treat-ment of single-segment(L5/S1)lumbar disc herniation(LDH).Methods A total of 100 LDH patients with single-segment(L5/S1)admitted from January 2019 to December 2021 were enrolled and divided into two groups according to the surgical procedure,with 50 cases for each group,and received nucleus pulposus extrac-tion with microscope-assisted Quadrant channel technique(as M-Q group)and PEID(as PEID group),respectively.The perioperative indexes were recorded,the visual analogue scale(VAS)and Oswestry dis-ability index(ODI)of low back pain and leg pain were compared between the two groups preoperatively and postoperatively.The clinical outcomes were evaluated by modified MacNab criteria at the last follow-up.Results All operations were successfully accomplished in all patients.The incision was smaller,and postoper-ative fist bed-off time and hospitalization time was shorter in the PEID group than those in the M-Q group,with statistical differences(P<0.05),while there was no significant difference in operation time between the two groups(P>0.05).Compared to preoperation,the VSA score of lumbago and leg pain and ODI were significantly improved on day 1,1-,3-,6-and 12 months after surgery in both groups(P<0.05).The VSA score of lumbago and leg pain and ODI were better on day 1 and 1 month after surgery in the M-Q group than those in the PEID group(P<0.05),and there were no significant differences between the two groups at 3-,6-and 12 months after operation(P>0.05).All patients were followed up for 12 to 24 months postoperatively,with an mean of(15.48±3.62)months.At the last follow-up,according to the modified MacNab criteria,the outcomes revealed excellent in 30 cases,good in 18 cases,fair in 1 case,poor in 1 case,with the fineness rate of 96.0%in the M-Q group,and excellent in 30 cases,good in 17 cases,fair in 2 cases,poor in 1 case,wit

关 键 词：腰椎间盘突出症 经皮内镜椎板间入路椎间盘切除术 显微镜 QUADRANT通道 

分 类 号：R687.3[医药卫生—骨科学]