复发性腰椎间盘翻修术的微创术式选择与临床应用

Microendoscopic strategies and options for recurrent lumbar disc herniation

目的评价内镜辅助下微创腰椎间盘翻修术的临床效果，并比较单纯减压与椎间融合、椎弓根螺钉内固定的临床结果。方法共32例微创腰椎间盘翻修术患者，男22例，女10例，平均45．7岁。其中27例患者获得随访（随访率84．4％），平均随访25．5个月。临床患者被分为二组：内镜下单纯减压组（14例）和内镜下减压、椎间植骨融合、椎弓根螺钉内固定组（13例）。疗效评定按照目测视觉类比评分法（VAS评分）和Nakai分级评定。结果二组患者术后平均腰腿痛VAS指数显著降低，手术前后差异有显著（P〈0．05）和极显著（P〈0．01）统计学意义。根据Nakai分级；单纯减压组优良率92．8％，减压内固定组优良率85．5％。虽然二组优良率间比较无统计学意义（P：0．793），但单纯减压组的手术时间、术中出血量、术后下床时间和治疗费用都显著低于减压内固定组（P〈0．05）。结论内镜下微创腰椎间盘翻修术非常有效和安全，内镜下单纯纤维瘢痕组织松解和椎间盘摘除减压是腰椎间盘翻修术的首选术式。

Objective To evaluate the results of microendoscopic revision surgery for recurrent disc herniation, and compare the results of disc excision with and without interbody fusion. Methods A total of 32 patients included who had undergone microendoscopic revision discectomy for recurrent disc herniation with or without interbody fusion has been surveyed to assess their clinical outcome. The 27 patients who had been followed were divided into two groups; the microendoscopic discectomy alone 14 eases, the microendoscopic disceetomy with interbody fusion 13 cases. With an average follow-up of 25.5 months. Clinical symptoms were assessed based on the VAS scores and Nakai criteria. All medical and surgical records were examined and analyzed, including intraoperative blood loss, length of surgery, and postsurgery hospital stay et al. Results The statistical difference in the postoperative back pain and leg pain score compared with prepoperative score were significant （ P 〈 0. 05 ） or very significant （ P 〈 0. 01 ）. Clinical outcomes were excellent or good in 92. 8% of patients undergoing a microendoscopic discectomy alone, and in 85.5% of patients with interbody fusion. The statistical difference between the fusion and non_fusion groups was insignificant （P = 0. 793 ）. But the two groups intraoperative blood loss, length of surgery, length of hospitalization and expenses were significantly less in patients undergoing diseectomy alone than in patients with interbody fusion. Conclusions Microendoscopic revision surgery for recurrent disc herniation is very effective and safety. Microendoscopie diseectomy alone is first choice for managing recurrent disc herniation.