可视环锯椎间孔成形经皮椎间孔镜椎间盘切除术△（开放获取）

Percutaneous transforaminal endoscopic discectomy with targeted foraminoplasty by visual trephine

摘要:

[目的]评价可视环锯椎间孔成形内镜椎间盘切除术治疗腰椎腰椎间盘脱出症的安全性及有效性。[方法]回顾性分析 2019 年 3 年—2021 年 7 月腰椎间盘脱出症在本科接受经椎间孔镜手术治疗的 58 例患者的临床资料。根据医患沟通结果， 30 例采用可视环锯椎间孔成形 （可视组），28 例采用不可视环锯 （不可视组）。比较两组围手术期、随访及影像资料。[结果] 可视组在手术时间 [(63.2±5.3) min vs (75.8±7.4) min, P＜0.001]、术中失血量 [(51.8±3.4) ml vs (59.2±4.9) ml, P＜0.001]、术中透视次数 [(4.2±0.6) 次 vs (10.5±1.2) 次, P＜0.001] 均显著优于不可视组，但两组切口长度、住院时间的差异无统计学意义（P＞0.05）。随访时间平均（17.4±6.5）个月，两组恢复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，两组术后 VAS 评分及 ODI 值均显著减少（P＜0.05），相同时间点，两组间 VAS 评分及 ODI 值差异均无统计学意义（P＞0.05）。影像方面，与术前相比，术后椎管占位率显著减小（P＜0.05），椎间隙高度及腰椎前凸角 Cobb 角无显著变化（P＞0.05），同一观察时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论]靶向椎间孔成形椎间孔镜手术治疗腰椎间盘脱出症临床疗效满意，可视环锯实现按需靶向成形，具有减少 X 线透视次数，缩短穿刺置管时间，减少穿刺成形出血量、减低患者术中疼痛感，提升患者术中体验等优势。

Abstract:

[Objective] To evaluate the safety and efficacy of endoscopic discectomy with targeted foraminoplasty by visual trephine in the treatment of lumbar disc prolapse. [Methods] A retrospective study was done on 58 patients who underwent percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc prolapse in our department from March 2019 to July 2021. According to doctor-patient communication, 30 patients underwent targeted foraminoplasty with visual trephine in the PTED (the visible group), with other 28 patients were with invisible trephine (the invisible group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The visual group proved significantly superior to the invisible group in terms of operation time [(63.2±5.3 min) vs (75.8±7.4) min, P＜0.001], intraoperative blood loss [(51.8±3.4) ml vs (59.2±4.9) ml, P＜0.001] and intraoperative fluoroscopy times [(4.2±0.6) times vs (10.5±1.2) times, P＜ 0.001], but there was no significant difference in incision length and hospital stay between the two groups (P＞0.05). The mean follow-up time was of (17.4±6.5) months, and there was no significant difference between the two groups in the time to return to full weight-bearing activities (P＞0.05). With time elapsed, the VAS and ODI scores were significantly decreased in both groups (P＜0.05), whereas which were not statistically significant between the two groups at any time point accordingly (P＞0.05). With regard of imaging, the vertebral canal space occupancy rate was significantly decreased (P＜0.05), whereas the vertebral space height and lumbar lordotic angle remained unchanged in both groups postoperatively compared with those preoperatively (P＞0.05), and there were no statistically significant differences in the abovementioned image parameters between the two groups at any time points correspondingly (P＞0.05). [Conclusion] The targeted foraminoplasty with visual trephine in PTED does achieve satisfactory clinical consequence for lumbar disc prolapse, with advantages of meeting the demand properly, reducing the number of X-ray fluoroscopy, shortening the puncture catheterization time, reducing bleeding, declining intraoperative pain of patients, and improving the patient's intraoperative experience.