内镜与通道经椎板切除青年巨大L5S1椎间盘突出

Endoscopic translaminar discectomy versus channel counterpart for large L5S1 disc herniation in young adults

摘要:

[目的] 比较 Delta 内镜与 Quadrant 通道经椎板间入路椎间盘切除治疗青年巨大 L₅S₁ 腰椎间盘突出症的临床效果。 [方法] 回顾性分析 2018 年 1 月—2020 年 12 月在本科微创手术治疗 62 例巨大 L₅S₁ 腰椎间盘突出症的青年患者的临床资料。 依据术前医患沟通结果，27 例采用内镜椎间盘切除术，35 例采用经通道椎间盘切除术。比较两组患者围手术期、随访和影像资料。[结果] 两组患者均顺利完成手术，均无严重并发症。虽然内镜组手术时间显著长于通道组 [(123.1±13.7)min vs (112.1± 13.3), P=0.002]，但是，内镜组术中失血量 [(15.6±3.1)ml vs (38.1±6.2)ml, P＜0.001]、切口总长度 [(1.1±0.3)cm vs (2.3±0.4)cm, P＜ 0.001]、下地行走时间 [(1.5±0.9)d vs (2.5±1.4)d, P＜0.001]、住院时间 [(6.1±1.4)d vs (8.4±1.7)d, P＜0.001] 均显著优于通道组。所有患者均获随访 12~36 个月，平均(24.1±5.2)个月，内镜组恢复完全负重时间显著早于通道组 [(88.2±1.2)d vs (90.2±1.4)d, P＜0.001]。 随时间推移，两组腰痛和腿痛 VAS 以及 ODI 评分均显著降低(P＜0.05)；术前两组间 VAS 和 ODI 评分的差异无统计学意义(P＞ 0.05)，出院时内镜组的腰痛 VAS 评分 [(3.0±0.9) vs (3.3±1.0), P=0.028]、腿痛 VAS 评分 [(3.0±0.8) vs (3.5±0.9), P=0.032] 和 ODI 评分 [(20.7±4.0) vs (23.0±3.5), P=0.019] 均显著优于通道组，但是末次随访时两组间上述评分的差异已无统计学意义(P＞0.05)。影像方面，随时间推移，两组椎间隙高度和腰椎前凸角(L₅S₁ Cobb 角)均无明显改变(P＞0.05)；但两组术后椎管面积较术前显著扩大 (P＜0.05)。相应时间点，两组间椎间隙高度、椎管面积和腰椎前凸角的差异均无统计学意义(P＞0.05)[结论] 对于治疗青年巨大腰椎间盘突出症，Delta 内镜椎间盘切除术相较于 Quadrant 通道术式创伤更小，更有利于早期恢复。

Abstract:

[Objective] To compare the clinical outcomes of percutaneous endoscopic interlaminar discectomy (PEID) with the Delta en- doscopy versus the counterpart through the Quadrant channel for large L₅S₁ disc herniation in young adults. [Methods] A retrospective study was performed on 62 young patients who underwent minimally invasive surgery for the giant L₅S₁ disc herniation in our department from Janu- ary 2018 to December 2020. According to the results of preoperative doctor-patient communication, 27 patients received the endoscopic dis- cectomy (ED), while the other 35 patients underwent the channel discectomy (CD). The perioperative period, follow-up and imaging data of the two groups were compared. [Results] All the patients in both groups had operation performed successfully without serious complications. Although the ED group consumed significantly longer operative time than the CD group [(123.1±13.7)min vs (112.1±13.3), P=0.002], the for- mer proved significantly superior to the latter in terms of intraoperative blood loss [(15.6±3.1)ml vs (38.1±6.2)ml, P＜0.001], total incision length [(1.1±0.3)cm vs (2.3±0.4)cm, P＜0.001], postoperative walking time [(1.5±0.9)days vs (2.5±1.4)days, P＜0.001] and hospital stay [(6.1± 1.4)days vs (8.4±1.7)days, P＜0.001]. All of them were followed up for 12 to 36 months, with a mean of (24.08±5.17) months, the patients in the ED group resumed full weight-bearing activity significantly earlier than those in the CD group [(88.2±1.2)days vs (90.2±1.4)days, P＜ 0.001]. The VAS scores for lumbago and leg pain, as well as ODI scores significantly decreased over time in both groups (P＜0.05). The VAS and ODI scores were not statistically significant between the two groups preoperatively (P＞0.05). The ED group was significantly superior to the CD group in terms of VAS score for low back pain [(3.0±0.9) vs (3.3±1.0), P=0.028], VAS score for leg pain [(3.0±0.8) vs (3.5±0.9), P= 0.032] and ODI score [(20.7±4.0) vs (23.0±3.5), P=0.019] at discharge from hospital, whereas which became not statistically significant be- tween the two groups at the last follow-up (P＞0.05). Imaging, intervertebral height and lumbar lordosis angle (L₅S₁ Cobb angle) were not sig-nificantly changed over time (P＞0.05), however, the spinal canal area was significantly enlarged in both groups postoperatively compared with those preoperatively (P＜0.05). There were no statistically significant differences in intervertebral height, spinal canal area and lumbar lordosis angle between the two groups at any time points accordingly (P＞0.05). [Conclusion] Compared with the Quadrant channel counter- part, Delta endoscopic discectomy is less invasive and more beneficial to early recovery for giant L₅S₁ disc herniation in young adult.