关节突是否对称对椎间孔镜切除腰椎间盘脱出的影响△

Impact of facet symmetry on clinical outcome of percutaneous percutaneous endoscopic transforaminal discectomy for lumbar disc herniation

摘要:

[目的] 探讨关节突是否对称对经皮椎间孔镜椎间盘切除术 （percutaneous endoscopic transforaminal discectomy, PETD） 治疗脱垂型腰椎间盘突出症的影响。[方法] 2022 年 9 月—2023 年 9 月共 30 例脱垂型腰椎间盘突出症患者接受 PETD 治疗，其中关节突对称组 20 例，非对称组 10 例，比较两组临床及影像结果。[结果]两组手术时间、术中透视次数、下地时间、住院时间的差异均无统计学意义 （P＞0.05）。所有患者均获得 3 个月以上随访，随时间推移，两组患者腰痛 VAS、腿痛 VAS、ODI、JOA 评分均显著改善 （P＜0.05），术后 1 d 及末次随访时，对称组的腰痛 VAS 评分 [(2.7±1.3) vs (6.8±1.2), P＜0.001; (1.7±0.7) vs (3.8±0.6), P＜0.001] 显著优于非对称组。影像方面，与术前相比，末次随访时两组患者椎间隙高度显著降低 （P＜ 0.05），椎管面积均显著增加（P＜0.05），末次随访时，对称组椎间隙高度 [(10.7±1.8) mm vs (7.0±1.8) mm, P＜0.001] 显著优于非对称组（P＜0.05）。[结论]PETD 治疗脱垂型腰椎间盘突出症临床疗效确切，但是对于术前就存在关节突关节不对称的患者，术后腰痛的症状可能会持续更久。

Abstract:

[Objective] To explore the impact of facet symmetry on clinical consequence of percutaneous endoscopic transforaminal discectomy (PETD) for prolapsed lumbar disc herniation. [Methods] A retrospective study was conducted on 30 patients who had prolapsed lumbar disc herniation treated with PETD, including 20 patients with symmetrical bilateral facets (SBF), and 10 patients with asymmetric bilateral facets (ABF) from September 2022 to September 2023. The clinical and imaging data of the two groups were compared. [Results] There were no significant differences in operation time, intraoperative fluoroscopy times, ambulation time and hospital stay between the two groups (P＞0.05). All patients were followed up for more than 3 months. As time went on, the lower back pain VAS, leg pain VAS, ODI and JOA scores in both groups were significantly improved (P＜0.05). The SBF group proved significantly superior to the ABF group in term of lower back pain VAS scores [(2.7±1.3) vs (6.8±1.2), P＜0.001; (1.7±0.7) vs (3.8±0.6), P＜0.001] 1 day postoperatively and at the last followup. As for imaging, the intervertebral space height and vertebral canal area in both groups were significantly increased at the last follow-up compared with those preoperatively (P＜0.05). At the last follow-up, the SBF group was also significantly better than the ASF group regarding to intervertebral space height [(10.7±1.8) mm vs (7.0±1.8) mm, P＜0.001]. [Conclusion] PETD is effective treatment for prolapsed lumbar disc herniation. However, the patients with preoperative asymmetry bilateral facets will last longer postoperative symptoms of low back pain.