后路内镜椎间盘切除凝胶囊富血小板血浆置入△（开放获取）

Posterior endoscopic discectomy combined with intervertebral implantation of platelet-rich plasma capsule

摘要:

[目的] 评价经皮内镜经椎板间椎间盘切除术 （percutaneous endoscopic interlaminar discectomy, PEID） 联合富血小板血浆 （platelet rich plasma, PRP） 凝胶囊治疗腰椎间盘突出症 （lumbar disc herniation, LDH） 的临床疗效。[方法] 回顾性分析 2018 年 3 月—2020 年 2 月 PEID 治疗 LDH 的 87 例患者的临床资料，依据术前医患沟通结果，45 例接受 PEID 联合 PRP 凝胶囊治疗 （PRP 组），42 例仅行 PEID 治疗 （无 PRP 组）。经倾向评分匹配 （propensity score matching, PSM），PRP 组 30 例，无 PRP 组 30 例列入本研究。比较两组围手术期、随访及影像学资料。[结果]两组手术时间、切口总长度、术中失血量、术中透视次数、下地行走时间、切口愈合等级及住院时间比较差异无统计学意义（P＞0.05）。随访时间平均（27.2±2.0）个月，两组完全负重活动时间的差异无统计学意义（P＞0.05）。随时间推移，两组 VAS、ODI 与 JOA 评分均较术前显著改善（P＜0.05）。术后 6 个月，PRP 组在腰痛 VAS [(1.9±0.8) vs (2.5±0.8), P＜0.05]、腿痛 VAS [(2.6±0.9) vs (3.1±0.9), P＜0.05]、ODI [(24.5±8.0) vs (29.5±8.3), P＜ 0.05] 与 JOA 评分 [(22.2±2.2) vs (21.0±2.1), P＜0.05] 均显著优于无 PRP 组。影像方面，随着时间推移，两组的硬膜囊横截面积（du- ral sac cross-sectional surface area, DCSA）、椎间盘高度指数 （disc height index, DHI）、髓核与脑脊液信号强度比 （signal intensity ratio, SIR）均显著改善（P＜0.05）。末次随访时，PRP 组在 DCSA [(215.6±12.9) mm² vs (208.3±13.2) mm² , P=0.034]、Pfirrmann 评级 [I/II/III/IV/V, (0/0/23/7/0) vs (0/0/15/11/4), P=0.037] 和 SIR [(24.6±2.3)% vs (23.0±3.3)%, P=0.033] 均显著优于无 PRP 组。[结论] PEID 联合 PRP 凝胶囊治疗 LDH 患者临床疗效确切且应用安全，一定程度上可延缓椎间盘的退变。

Abstract:

[Objective] To evaluate the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) combined with intervertebral implantation of platelet-rich plasma capsule for lumbar disc herniation (LDH). [Methods] A retrospective study was performed on 87 patients who received PEID for LDH from March 2018 to February 2020. According to the preoperative doctor-patient communication, 45 patients received PEID combined with PRP capsule (the PRP group), while other 42 patients received PEID alone (the nonPRP group). By propensity score matching (PSM), 30 patients in the PRP group and 30 patients in the non-PRP were included in this study. The perioperative period, follow-up and imaging data of the two groups were compared. [Results] There were no significant differences in operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times, walking time, incision healing grade and hospital stay between the two groups (P＞0.05). The follow-up period lasted for (27.2±2.0) months on a mean, and there was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The VASs, ODI and JOA score were significantly improved over time in both groups (P＜0.05). At 6 months postoperatively, the PRP group proved significantly superior to the non-PRP group in terms of low back pain VAS [(1.9 ±0.8) vs (2.5±0.8), P＜0.05], leg pain VAS [(2.6±0.9) vs (3.1± 0.9), P＜0.05], ODI [(24.5± 8.0) vs (29.5± 8.3), P＜ 0.05] and JOA score [(22.2±2.2) vs (21.0±2.1), P＜0.05]. Radiographically, the dural sac cross-sectional surface area (DCSA), disc height index (DHI), and signal intensity ratio (SIR) between nucleus pulposus and cerebrospinal fluid were significantly improved in both group over time (P＜0.05). At the last follow-up, the PRP group were significantly better than non-PRPgroup in terms of DCSA [(215.6±12.9) mm² vs (208.3±13.2) mm² , P=0.034], Pfirrmann grade of disc degeneration [I/II/III/IV/V, (0/0/23/7/0) vs (0/0/15/11/4), P=0.037], and SIR [(24.6± 2.3)% vs (23.0±3.3)%, P=0.033]. [Conclusion] The PEID combined with PRP capsule is effective and safe in the treatment of LDH, and might delay the degeneration of intervertebral disc to a certain extent.