经椎间孔与经椎板间内镜治疗腰椎间盘重度脱出
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作者简介:

王龙强,主治医生,研究方向:脊柱外科,(电话)13516310170,(电子信箱)wanglongqiangpaddy@163.com

中图分类号:

R681.53


Percutaneous endoscopic transforaminal discectomy versus translaminar counterpart for severely migrated lumbar disc prolapse
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    摘要:

    目的] 比较经椎间孔与经椎板间内镜治疗重度脱出型腰椎间盘突出症的临床疗效。[方法] 2018 年 1 月—2019 年 1 月本院收治重度脱出型腰椎间盘突出症患者 60 例,随机分为两组。其中,30 例采用经椎间孔内镜术,30 例采用经椎板间内镜术。比较两组围手术期、随访及影像资料。[结果]经椎间孔组有 3 例因术中无法完成手术而退出,最终共 57 例患者纳入结果分析。两组切口长度、切除髓核体积、下地行走时间、早期并发症、住院时间比较差异均无统计学意义(P> 0.05)。经椎板间组手术时间、术中失血量和透视次数均显著优于经椎间孔组(P<0.05)。随访 12~15 个月,随时间推移,两组 VAS 和 ODI 评分显著降低 (P<0.05),而 JOA 评分均显著增加 (P<0.05),但相应时间点,两组上述指标的差异均无统计学意义 (P>0.05)。影像方面,与术前相比,末次随访时两组椎间隙高度均显著降低 (P<0.05),而腰椎前凸角无显著改变 (P>0.05)。相同时间点两组在椎间隙高度、腰椎前凸角的差异均无统计学意义 (P>0.05)。[结论]经椎间孔入路和经椎板间入路治疗重度脱出型腰椎间盘突出症均能取得较好的临床疗效,椎板间入路更具有优势。

    Abstract:

    [Objective] To compare the clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) versus percuta- neous endoscopic interlaminar discectomy (PEID) for severely prolapsed lumbar disc herniation. [Methods] A total of 60 patients who admit- ted to our hospital from January 2018 to January 2019 for severely migrated lumbar disc prolapse were randomly divided into two groups. Among them, 30 patients were undergoing PETD, while the other 30 patients were undergoing PEID. The perioperative, follow-up and imag- ing data of the two groups were compared. [Results] In the PETD group, 3 patients were withdrawn from this study due to unable complete of the operation on plan, therefore a total of 57 patients were included in the study finally. Although there were no significant differences between the two groups in terms of incision length, volume of nucleus pulposus resected, ambulation time, early complications and hospital stay be- tween the two groups (P<0.05) , the PEID group proved significantly superior to the PETD group in terms of operation time, intraoperative blood loss and fluoroscopy times (P<0.05) . The VAS scores for low back pain and leg pain, as well as ODI scores decreased significantly (P< 0.05) , whereas JOA scores increased significantly in both groups over time (P<0.05) . However, there was no statistically significant differ- ence between the two groups in aforesaid scores at any matching time points (P>0.05) . Radiographically, the height of the intervertebral space significantly declined (P<0.05) , while lumbar lordosis angle remained unchanged significantly (P>0.05) in both groups at the latest follow up compared with those preoperatively. There were no significant differences in intervertebral height and lumbar lordosis angle between the two groups at any corresponding time points (P>0.05) . [Conclusion] Both PETD and PEID are effective for treatment of severely prolapsed lum- bar disc herniation, by comparison, the PEID takes more advantages.

    参考文献
    [1] Hirano Y,Mizuno J,Takeda M,et al.Percutaneous endoscopiclumbar discectomy early clinical experience [J].Neurol Med Chir(Tokyo),2012,52(9):625-630.
    [2] Wu X,Fan G,Gu X,et al.Surgical outcome of two-level transfo?raminal percutaneous endoscopic lumbar discectomy for far-mi?grated disc herniation [J].Biomed Res Int,2016,2016:4924013.
    [3] Lee S,Kim SK,Lee SH,et al.Percutaneous endoscopic lumbar dis?cectomy for migrated disc herniation:classification of disc migra?tion and surgical approaches [J].Eur Spine J,2007,16(3):431-437.
    [4] 杨虎,李鹏飞,贾楠,等.椎间孔镜不同入路方式对髓核摘除量的影响及临床疗效分析 [J].中国修复重建外科杂志,2018,32(7):933-940.
    [5] Kim JS,Choi G,Lee SH.Percutaneous endoscopic lumbar discec?tomy via contralateral approach:a technical case report [J].Spine(Phila Pa 1976),2011,36(17):E1173-1178.
    [6] Choi KC,Kim JS,Ryu KS,et al.Percutaneous endoscopic lumbardiscectomy for L5-S1 disc herniation:transforaminal versus inter?laminar approach [J].Pain Physician,2013,16(3):547-556.
    [7] 吴冠男,张世民,刘昱彰,等.椎板间入路椎间孔镜下治疗 L2~5移位型腰椎间盘突出症 [J].中国骨伤,2018,31(8):718-722.
    [8] 田大胜,朱斌,刘建军,等.单边双通道内镜技术治疗脱出游离型腰椎间盘突出症 [J].中国微创外科杂志,2020,20(12):1083-1087.
    [9] 宋晓磊,王红建,黄鹏博,等.经皮内镜椎板间开窗与椎间孔入路治疗腰椎间盘突出症的比较 [J].中国微创外科杂志,2021,21(5):405-408.
    [10] 徐彬,徐峰,李涛,等.经皮椎间孔镜技术治疗脱出游离型腰椎间盘突出症的临床研究 [J].中国矫形外科杂志,2018,26(9):769-774.
    [11] Ahn Y,Jang IT,Kim WK.Transforaminal percutaneous endoscop?ic lumbar discectomy for very high-grade migrated disc herniation[J].Clin Neurol Neurosurg,2016,147(1):11-17.
    [12] Wei H,Shunli K,Zehua J,et al.Comparative study of three mini?mally invasive surgical approaches for the treatment of L5S1 lumbarintervertebral disc herniation [J].Turk Neurosurg,2021,31(3):324-332.
    [13] Ruetten S,Komp M,Merk H,et al.Recurrent lumbar disc hernia?tion after conventional discectomy:a prospective,randomizedstudy comparing full endoscopic interlaminar and transforaminalversus microsurgical revision [J].J Spinal Disord Tech,2009,22(2):122-129.
    [14] Choi KC,Lee DC,Shim HK,et al.A strategy of percutaneous endo?scopic lumbar discectomy for migrated disc herniation [J].WorldNeurosurg,2017,99(3):259-266.
    [15] Liu C,Chu L,Yong HC,et al.Percutaneous endoscopic lumbardiscectomy for highly migrated lumbar disc herniation [J].PainPhysician,2017,20(1):E75-E84.
    [16] 王红升.椎间孔入路与椎板间入路经皮全脊柱内镜下髓核摘除术治疗L5S1节段椎间盘突出症的疗效比较 [J].颈腰痛杂志,2020,41(4):412-416.
    [17] Kim CH,Chung CK,Woo JW.Surgical outcome of percutaneousendoscopic interlaminar lumbar discectomy for highly migrateddisk herniation [J].J Spinal Disorders Tech,2012,29(5):E259.
    [18] 蒋强,刘金玉,曹世奇,等.有限元模拟全内镜下精准椎板开窗减压术及生物力学分析 [J].中国组织工程研究,2020,24(12):1891-1896.
    [19] 周跃,罗刚,初同伟,等.腰椎单侧小关节突分级切除的生物力学影响及微创外科的修复与重建 [J].中华医学杂志,2007,87(19):1334-1338.
    [20] 刘佐忠,黄黎黎,卢旻鹏,等.经椎间孔入路经皮内窥镜下椎间盘切除术治疗脱出型和游离型腰椎椎间盘突出症 [J].脊柱外科杂志,2017,15(1):18-23.
    [21] Puvanesarajah V,Hassanzadeh H.The true cost of a dural tear:medical and economic ramifications of incidental durotomy during?lumbar discectomy in elderly medicare beneficiaries [J].Spine(Phila Pa1976),2017,42(10):770-776.
    [22] Murphy ME,Hakim JS,Kerezoudis P,et al.Micro vs macrodis?cectomy:does use of the microscope reduce complication rates [J].Clin Neurol Neurosurg,2017,15(2):28-33.
    [23] 陈松,张为,索世琪,等.经皮椎间孔镜治疗重度脱垂移位型腰椎间盘突出症 [J].中国矫形外科杂志,2020,28(19):1748-1752.
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王龙强,付松,邵诗泽,等. 经椎间孔与经椎板间内镜治疗腰椎间盘重度脱出[J]. 中国矫形外科杂志, 2022, 30 (13): 1163-1168. DOI:10.3977/j. issn.1005-8478.2022.13.03.
WANG Long-qiang, FU Song, SHAO Shi-ze, et al. Percutaneous endoscopic transforaminal discectomy versus translaminar counterpart for severely migrated lumbar disc prolapse[J]. Orthopedic Journal of China , 2022, 30 (13): 1163-1168. DOI:10.3977/j. issn.1005-8478.2022.13.03.

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  • 收稿日期:September 01,2021
  • 最后修改日期:May 31,2022
  • 在线发布日期: June 29,2023