椎间盘区域定位分型方法在经皮腰椎间孔镜手术中的应用及对术后预后的影响  

Application of disc region localization and classification method in percutaneous endoscopic lumbar discectomy and its predictive role on postoperative prognosis

作　　者：李涛 叶记超[1,2] 李双星 谢天宇 欧茂塔 王镇波 李敏 范吉 唐勇[2] LI Tao;YE Ji-chao;LI Shuang-xing;XIE Tian-yu;OU Mao-ta;WANG Zhen-bo;LI Min;FAN Ji;TANG Yong(Department of Orthopedics,Shenshan Medical Center,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Shanwei,Guangdong 516600,China;Department of Orthopedics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院深汕中心医院骨外科,广东汕尾516600 [2]中山大学孙逸仙纪念医院骨外科,广州510120

出　　处：《岭南现代临床外科》2025年第1期47-53,共7页Lingnan Modern Clinics in Surgery

基　　金：汕尾市科技计划(社会发展领域)项目(2023C014);广东省医学科学科研基金项目(A2024721);广东省中医药局科研项目(20241340)。

摘　　要：目的本研究旨在通过改良的椎间盘区域定位分型方法,提高经皮腰椎间孔镜手术(PELD)术前评估的精准性,为患者术后功能恢复和复发风险的个体化预测提供新依据。方法本研究为回顾性队列研究,纳入2022年1月1日至2023年9月30日间在中山大学孙逸仙纪念医院深汕中心医院接受PELD治疗的113名腰椎间盘突出症(LDH)患者。结合影像学资料应用区域定位分型方法,记录椎间盘在矢状面、横断面和冠状面三个平面上的位置及最突出点。通过术前的影像学资料及临床评估(VAS评分、JOA评分、ODI评分等),系统分析术前应用区域定位分型对术后恢复及预后的影响。结果LDH患者中L5/S1和L4/5是最常见的受累节段。椎间盘最突出点能够有效预测术后1年患者功能恢复情况如VAS评分(P=0.039)、JOA评分(P=0.031)以及ODI评分(P=0.045)。另PELD手术患者术中失血量更少,住院时间更短。结论本研究提示改良的区域定位分型方法能够为接受PELD手术的腰椎间盘突出患者提供新的预测方法,以借此评估不同患者预后差异及可能的复发概率。Objective This study aims to improve the accuracy of preoperative evaluation for percutaneous endoscopic lumbar discectomy(PELD)through a modified regional localization and classification method for intervertebral discs,providing a new basis for individualized prediction of postoperative functional recovery and recurrence risk for patients.Methods This is a retrospective cohort study including 113 patients with LDH who underwent PELD treatment at Shenshan Medical Center,Sun Yat⁃sen Memorial Hospital,Sun Yat⁃sen University,between January 1,2022,and September 30,2023.The regional localization and classification method was applied based on imaging data to record the position and most protruding point of the intervertebral disc in the sagittal,transverse,and coronal planes.Through preoperative imaging data and clinical evaluations(VAS score,JOA score,ODI score,etc.),the impact of regional localization and classification on postoperative recovery and prognosis was systematically analyzed.Results L5/S1 and L4/5 were the most commonly affected segments among LDH patients.Furthermore,the most protruding point of the intervertebral disc could effectively predict patients′functional recovery at 1 year postoperatively,as indicated by VAS score(P=0.039),JOA score(P=0.031),and ODI score(P=0.045).Additionally,PELD surgery reduced intraoperative blood loss,shortened hospital stay,and contributed to rapid recovery for patients.Conclusion This study suggests that the modified regional localization and classification method can provide a new predictive approach for different patients with intervertebral disc herniation undergoing PELD surgery,thereby assessing prognostic differences and potential recurrence probabilities among various patients.

关 键 词：腰椎间盘突出症 经皮腰椎间孔镜手术 椎间盘区域定位分型 术后预后 

分 类 号：R681.5[医药卫生—骨科学]