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[1]翟亞業(yè),秦曉彬,孟祥翔,等.可視化椎間孔成形技術(shù)在經(jīng)皮椎間孔入路內(nèi)鏡下椎間盤切除術(shù)治療巨大型腰椎間盤突出癥中的應(yīng)用…[J].中醫(yī)正骨,2022,34(01):22-27.
　ZHAI Yaye,QIN Xiaobin,MENG Xiangxiang,et al.Application of visualization foraminoplasty in percutaneous endoscopic transforaminal discectomy for treatment of giant lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(01):22-27.
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可視化椎間孔成形技術(shù)在經(jīng)皮椎間孔入路內(nèi)鏡下椎間盤切除術(shù)治療巨大型腰椎間盤突出癥中的應(yīng)用…()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期數(shù):
2022年01期
頁(yè)碼:
22-27
欄目:
臨床研究
出版日期:
2022-01-20

文章信息/Info

Title:
Application of visualization foraminoplasty in percutaneous endoscopic transforaminal discectomy for treatment of giant lumbar disc herniation
作者:
翟亞業(yè); 秦曉彬; 孟祥翔; 張超遠(yuǎn)
(南陽(yáng)市中心醫(yī)院,河南 南陽(yáng) 473003)
Author(s):
ZHAI Yaye; QIN Xiaobin; MENG Xiangxiang; ZHANG Chaoyuan
Nanyang Central Hospital,Nanyang 473003,Henan,China
關(guān)鍵詞:
椎間盤移位;  腰椎;  椎間盤切除術(shù);  內(nèi)窺鏡
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  diskectomy;  endoscopes
摘要:
目的:探討可視化椎間孔成形技術(shù)在經(jīng)皮椎間孔入路內(nèi)鏡下椎間盤切除術(shù)(percutaneous endoscopic transforaminal discectomy,PETD)治療巨大型腰椎間盤突出癥(lumbar disc herniation,LDH)中的應(yīng)用價(jià)值。方法:回顧性分析采用PETD治療的67例巨大型LDH患者的病例資料,術(shù)中采用可視化椎間孔成形技術(shù)者歸于可視化椎間孔成形組(31例),采用常規(guī)椎間孔成形技術(shù)者歸于常規(guī)椎間孔成形組(36例)。比較2組患者術(shù)中X線透視次數(shù)、通道建立用時(shí)、手術(shù)時(shí)間、上關(guān)節(jié)突骨切除量、術(shù)后住院時(shí)間、臨床綜合療效、并發(fā)癥發(fā)生率、LDH復(fù)發(fā)率,以及手術(shù)前后不同時(shí)間點(diǎn)(術(shù)前、術(shù)后1周、術(shù)后1個(gè)月、術(shù)后3個(gè)月、末次隨訪時(shí))的腰部、腿部疼痛視覺模擬量表(visual analogue scale,VAS)評(píng)分和Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)。結(jié)果:①一般結(jié)果。可視化椎間孔成形組術(shù)中X線透視次數(shù)較常規(guī)椎間孔成形組少[(12.48±3.15)次,(23.58±7.07)次,t=-8.073,P=0.000],通道建立用時(shí)、手術(shù)時(shí)間較常規(guī)椎間孔成形組短[(21.61±6.09)min,(30.89±9.59)min,t=-4.637,P=0.000;(53.39±12.25)min,(65.31±11.76)min,t=-4.508,P=0.000],上關(guān)節(jié)突骨切除量較常規(guī)椎間孔成形組多[(0.69±0.16)cm3,(0.40±0.14)cm3,t=7.659,P=0.000]; 2組患者術(shù)后住院時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(3.74±1.48)d,(3.97±1.30)d,t=-0.678,P=0.500]。②腰部、腿部疼痛VAS評(píng)分。時(shí)間因素和分組因素均存在交互效應(yīng)(F=216.417,P=0.000; F=275.367,P=0.000)。手術(shù)前后不同時(shí)間點(diǎn)之間腰部、腿部疼痛VAS評(píng)分的差異均有統(tǒng)計(jì)學(xué)意義,即均存在時(shí)間效應(yīng)(F=219.335,P=0.000; F=281.412,P=0.000)。2組患者腰部、腿部疼痛VAS評(píng)分總體比較,組間差異均無(wú)統(tǒng)計(jì)學(xué)意義,即均不存在分組效應(yīng)(F=0.016,P=0.899; F=0.258,P=0.613)。2組患者腰部、腿部疼痛VAS評(píng)分均隨時(shí)間呈下降趨勢(shì),且2組的變化趨勢(shì)一致[腰部疼痛VAS評(píng)分:(5.90±1.33)分,(2.52±0.72)分,(2.13±0.81)分,(1.71±0.64)分,(1.52±0.68)分,F=80.215,P=0.000;(5.78±1.07)分,(2.64±0.60)分,(2.17±0.78)分,(1.64±0.64)分,(1.47±0.65)分,F=153.720,P=0.000。腿部疼痛VAS評(píng)分:(6.61±1.26)分,(2.45±0.77)分,(1.84±0.74)分,(1.65±0.61)分,(1.42±0.62)分,F=118.069,P=0.000;(6.75±1.34)分,(2.50±0.81)分,(1.89±0.79)分,(1.72±0.66)分,(1.47±0.70)分,F=146.603,P=0.000]。③ODI。時(shí)間因素和分組因素存在交互效應(yīng)(F=479.277,P=0.000)。手術(shù)前后不同時(shí)間點(diǎn)之間ODI的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=476.994,P=0.000)。2組患者ODI總體比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,即不存在分組效應(yīng)(F=0.022,P=0.882)。2組患者ODI均隨時(shí)間呈下降趨勢(shì),且變化趨勢(shì)一致[(59.23±9.85)%,(24.39±6.08)%,(18.84±5.31)%,(13.81±3.55)%,(10.71±2.95)%,F=188.572,P=0.000;(57.83±8.42)%,(23.50±5.62)%,(18.89±5.39)%,(14.83±3.78)%,(11.33±3.28)%,F=327.092,P=0.000]。④臨床綜合療效。可視化椎間孔成形組優(yōu)19例、良8例、可3例、差1例,常規(guī)椎間孔成形組優(yōu)18例、良12例、可4例、差2例; 2組患者臨床綜合療效比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Z=-0.898,P=0.369)。⑤并發(fā)癥及LDH復(fù)發(fā)情況。2組患者均無(wú)神經(jīng)血管損傷、椎間隙感染等并發(fā)癥發(fā)生; 常規(guī)椎間孔成形組術(shù)后髓核殘留1例,二次行PETD治療后癥狀緩解; 2組患者并發(fā)癥發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=1.000)。2組各有1例患者術(shù)后LDH復(fù)發(fā),行腰椎融合術(shù)后癥狀緩解; 2組患者LDH復(fù)發(fā)率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P=1.000)。結(jié)論:PETD治療巨大型LDH,術(shù)中采用可視化椎間孔成形技術(shù)與采用常規(guī)椎間孔成形技術(shù),均可緩解腰腿疼痛、改善腰椎功能,二者療效相當(dāng); 在術(shù)后住院時(shí)間、安全性、LDH復(fù)發(fā)率等方面,二者也相當(dāng); 但前者可減少術(shù)中射線輻射、縮短手術(shù)時(shí)間、提高椎間孔成形的效率。
Abstract:
Objective:To explore the application value of visualization foraminoplasty in percutaneous endoscopic transforaminal discectomy(PETD)for treatment of giant lumbar disc herniation(LDH).Methods:The medical records of 67 patients who underwent PETD for treatment of giant LDH were analyzed retrospectively.The visualization foraminoplasty was employed during the PETD in 31 patients(visualization foraminoplasty group),and the conventional foraminoplasty was employed during the PETD in 36 ones(conventional foraminoplasty group).The intraoperative X-ray exposure,time spent in building passageway,operative time,bone resection volume of superior articular process(SAP),postoperative hospital stay,clinical outcome,incidence rate of postoperative complication,recurrence rate of LDH as well as the lumbago-leg pain visual analogue scale(VAS)score and Oswestry disability index(ODI)measured before the PETD,on week 1,month 1,month 3 after the PETD and at the last follow-up were compared between the 2 groups.Results:①The intraoperative X-ray exposure was fewer,the time spent in building passageway and operative time were shorter,the bone resection volume of SAP was larger in visualization foraminoplasty group compared to conventional foraminoplasty group(12.48±3.15 vs 23.58±7.07 times,t=-8.073,P=0.000; 21.61±6.09 vs 30.89±9.59 minutes,t=-4.637,P=0.000; 53.39±12.25 vs 65.31±11.76 minutes,t=-4.508,P=0.000; 0.69±0.16 vs 0.40±0.14 cm(3),t=7.659,P=0.000).There was no statistical difference in postoperative hospital stays between the 2 groups(3.74±1.48 vs 3.97±1.30 days,t=-0.678,P=0.500).②There was interaction between time factor and group factor in lumbago-leg pain VAS score(F=216.417,P=0.000; F=275.367,P=0.000).There was statistical difference in lumbago-leg pain VAS scores between different timepoints before and after the PETD,in other words,there was time effect(F=219.335,P=0.000; F=281.412,P=0.000).There was no statistical difference in lumbago-leg pain VAS scores between the 2 groups in general,in other words,there was no group effect(F=0.016,P=0.899; F=0.258,P=0.613).The lumbago-leg pain VAS scores presented a time-dependent decreasing trend in the 2 groups,and the 2 groups were consistent with each other in the variation tendency(lumbago VAS score:5.90±1.33,2.52±0.72,2.13±0.81,1.71±0.64,1.52±0.68 points,F=80.215,P=0.000; 5.78±1.07,2.64±0.60,2.17±0.78,1.64±0.64,1.47±0.65 points,F=153.720,P=0.000.leg pain VAS score:6.61±1.26,2.45±0.77,1.84±0.74,1.65±0.61,1.42±0.62 points,F=118.069,P=0.000; 6.75±1.34,2.50±0.81,1.89±0.79,1.72±0.66,1.47±0.70 points,F=146.603,P=0.000)...

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更新日期/Last Update: 1900-01-01