从“骨错缝、筋出槽”理论探析腰椎间盘突出症椎间孔镜术后残余症状影响因素

Analysis of Influencing Factors of Residual Symptoms of Lumbar Disc Herniation after Transforaminal Endoscopic Surgery Based on Theory of Bone Dislocation and Tendon Out of Groove

目的通过腰椎间盘突出症的影像学分析,探讨"骨错缝、筋出槽"病理改变与椎间孔镜术后残余症状的相关性。方法回顾2018年2月—2020年2月在该院接受椎间孔镜治疗的612例腰椎间盘突出症患者,根据纳排标准排除患者241例。剩余371例中术后出现残余症状的患者有45例,设为观察组,另从术后获得满意疗效的326例患者中采用性别分层按照随机数字表法选取45例作为对照组。运用影像归档和通信系统(PACS)对两组患者的影像资料作棘突偏歪距离、椎体旋转角度、双侧关节突关节间隙差值和椎间隙下降高度等"骨错缝"方面以及黄韧带厚度变化等"筋出槽"方面的测量。结果棘突偏歪:观察组的棘突偏移距离术前与术后均明显大于对照组(P<0.05),两组棘突偏移术后与术前比未发生明显改变(P>0.05);椎体旋转:观察组的椎体旋转度多于对照组(P<0.05);关节突关节间隙:观察组双侧关节突关节间隙差值(即小关节紊乱程度)大于对照组(P<0.05);椎间隙高度:两组术前椎间隙高度差异无统计学意义(P>0.05),观察组术后椎间隙高度小于对照组(P<0.05);黄韧带厚度:两组术前黄韧带厚度基本一致(P>0.05),观察组术后黄韧带厚度大于对照组(P<0.05)。故观察组患者棘突偏歪、椎体旋转、小关节紊乱及椎间隙高度丢失等"骨错缝"的程度及黄韧带挛缩增厚等"筋出槽"的程度明显大于对照组,差异具有统计学意义。结论腰椎"骨错缝、筋出槽"的病理状态与椎间孔镜术后残余症状关系密切,是影响腰椎术后疗效的关键因素。

Objective To investigate the correlation between the pathological changes of“bone dislocation and tendon out of groove”and the residual symptoms after transforaminal endoscopic surgery through imaging analysis of lumbar disc herniation.Methods A total of 612 cases of lumbar disc herniation treated by transforaminal endoscopy in our hospital from February 2018 to February 2020 were reviewed and 241 patients were excluded according to the inclusion and exclusion criteria.Among the remaining 371 cases,45 cases had residual symptoms after operation,which were set as the observation group,and 45 cases were selected as the control group according to gender stratification and random number table method.PACS system was used to measure the“bone dislocation”such as the deviation distanco of spinous process deviation,the rotation angle of vertebral rotation,the difference between bilateral facet joint space and the descending height of intervertebral space,and“tendon out of groove”such as the thickness change of ligamentum flavum.Results Spinous process deviation:The deviation distance of spinous process in the observation group was significantly larger than that in the control group before and after operation(P<0.05).Spinous process deviation in two groups had no significant change before and after operation.Vertebral rotation:The rotation degree of the observation group was more than that of the control group(P<0.05).Facet joint space:the difference of bilateral facet joint space in the observation group was greater than that in the control group(P<0.05).Intervertebral space height:There was no significant difference between the two groups before operation(P>0.05),but the height in the observation group was lower than that in the control group after operation(P<0.05).The thickness of ligamentum flavum:The thickness of ligamentum flavum in the two groups was basically the same as that before operation(P>0.05),but the thickness of ligamentum flavum in the observation group was greater than that in the control group(P<0.05).Therefore,the degree of“bone dislocation”and“tendon out of groove”in the observation group were significantly greater than those in the control group,and the difference was statistically significant.Conclusion The pathological state of lumbar“bone dislocation and tendon out of groove”is closely related to the residual symptoms after transforaminal endoscopic surgery,and it is the key factor affecting the curative effect of lumbar surgery.