钬激光在经皮内窥镜下腰椎间盘髓核切除术中的临床应用

Clinical comparative study of holmium laser in percutaneous endoscopic lumbar discectomy

目的 :评价钬激光在经皮内窥镜下腰椎间盘髓核切除术(percutaneous endoscopic lumbar discectomy,PELD)中应用的安全性和有效性。方法:2016年1月～2016年7月我院采用经皮内窥镜下椎板间入路或椎间孔入路腰椎间盘髓核切除术治疗138例腰椎间盘突出症(lumbar disc herniation,LDH)患者,按术中是否联合应用钬激光分为A、B组:A组,PELD术中联合应用钬激光;B组,行常规PELD。记录两组手术时间、住院天数、并发症和复发等情况,以及术前/后患者腰痛、下肢痛视觉模拟疼痛评分(visual analog scale,VAS)和腰椎功能障碍指数(Oswestry disability index,ODI),采用改良MacNab标准评价临床疗效。结果:所有138例患者均完成至少2年随访,平均28.2±6.4个月。其中A组66例,B组72例,两组患者年龄、性别、体质指数、病变节段、突出类型及手术入路方式等差异无统计学意义(P>0.05);平均手术时间A组为48.2±7.3min,B组为56.2±10.7min,差异有统计学意义(P<0.05);平均住院天数A组为4.1±1.1d,B组为4.2±0.9d,差异无统计学意义(P>0.05);术后3d、1年和2年随访,两组腰痛、下肢痛VAS和腰椎ODI评分均较术前有显著改善(P<0.05)。两组间术后下肢痛VAS评分差异无统计学意义(P>0.05),而腰痛VAS评分A组低于B组且差异有统计学意义(P<0.05)。两组各有1例术后发生暂时性神经根麻痹。术后第1年内,A组1例复发,B组7例复发,差异有统计学意义(P<0.05);术后第2年内,A组2例复发,B组1例复发,差异无统计学意义(P>0.05),改良Macnab标准评价优良率分别为87.5%(A组)和85.2%(B组),差异无统计学意义(P>0.05)。结论:钬激光在PELD临床应用中安全、有效,能够显著提高手术效率、减轻LDH患者腰痛症状且降低术后早期复发发生率。

Objectives: To evaluate the safety and efficacy of holmium laser in percutaneous endoscopic lumbar discectomy(PELD) for lumbar disc herniation(LDH). Methods: From January 2016 to July 2013, 138 cases with LDH undergoing percutaneous endoscopic lumbar discectomy via an interlaminar or transforaminal approach in our institution were divided randomly into group A and group B. Patients in group A underwent the PELD combined application of holmium laser, while patients in group B underwent the regular PELD. Clinical data including the operation time, hospitalization, complications and recurrence were recorded. Clinical outcomes were assessed according to the visual analogue scale(VAS), Oswestry disability index(ODI) and modified MacNab criteria. Results: A total of 138 cases completed minimum of 2-year follow-up, with an average of 28.2±6.4 months. Threre were 66 cases in group A and 72 cases in group B. There was no significant difference in general information between the two groups(P >0.05). The mean operation time in group A and B was 48.2±7.3min and 56.2±10.7min, respectively, with a statistical significance(P<0.05). The hospitalization in group A and B was 4.2±0.9d and 4.1±1.1d, respectively, with no statistical significance(P >0.05). The postoperative VAS scores for back and leg pain, as well as the ODI, obviously improved in both groups when compared with those of preoperation(P<0.05). There was no significant difference in postoperative VAS score for leg pain between the 2 groups, however, postoperative VAS score for back pain of group B was lower than that of group A, with a statistical significance(P<0.05). Transient dysesthesia occurred in 1 patient in each group. In the 1st year after surgery, recurrence occurred in 1 patient in group A and 7 patients in group B, with a statistical significance(P<0.05). In the 2nd year after surgery, recurrence occurred in 2 patients in group A and 1 patient in group B, with no statistical significance(P >0.05). According to the MacNab criteria, the satisfactory rate was 85.2% and 87.5% in group A and B, respectively, with no statistical significance(P >0.05). Conclusions: Clinical application of holmium laser in PELD for LDH is safe and effective, and it is favorable to the enhancement of operative efficiency, the relief of back pain and the reduction of recurrencerate in the early stage after operation.