经皮椎间孔镜联合Coflex棘突间动力重建系统植入治疗青年腰椎间盘突出症

Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation

目的探讨经皮椎间孔镜下摘除突出髓核联合Coflex棘突间动力重建系统(以下简称Coflex)植入治疗青年腰椎间盘突出症(lumbar disc herniation,L_DH)的近期疗效。方法回顾分析2013年2月—2015年3月采用经皮椎间孔镜下摘除突出髓核联合棘突间植入Coflex治疗的52例青年L_DH患者临床资料,其中L_4、530例、L_5、S122例。L_(4、5)患者中男18例、女12例;年龄18~34岁,平均25岁;病程6~16个月,平均10个月。L_5、S1患者中男10例、女12例;年龄19~32岁,平均25.5岁;病程6~18个月,平均12个月。记录手术时间、术中出血量。采用Oswestry功能障碍指数(ODI)及日本骨科协会(JOA)评分评价临床疗效;X线片测量病变节段椎体间腹侧高度(ventral intervertebral space height,VH)、椎体间背侧高度(dorsal intervertebral space height,DH)、椎间孔高度(intervertebral foramen height,IFH)、椎间活动度及其上位相邻节段椎间活动度。结果52例患者均顺利完成手术。L_4、5患者手术时间(89.7±16.5)min、术中出血量(42.7±11.3)mL,L_5、S1患者分别为(94.6±18.2)min、(47.6±13.4)mL。术后切口均Ⅰ期愈合。患者均获随访,其中L_(4、5)患者随访时间12~18个月,平均16个月;L_5、S1患者为12~20个月,平均17个月。末次随访时,L_4、5及L_5、S1患者ODI、JOA评分均较术前改善,比较差异有统计学意义(P<0.05)。X线片复查示,患者均未出现Coflex松动、棘突骨折、关节突骨折等并发症。末次随访时,L_4、5及L_5、S1患者病变节段VH、DH、IFH均较术前提高,比较差异有统计学意义(P<0.05);病变节段椎间活动度较术前降低,比较差异亦有统计学意义(P<0.05);而上位相邻节段椎间活动度与术前比较,差异无统计学意义(P>0.05)。结论对于青年L_DH患者,经皮椎间孔镜联合棘突间植入Coflex是一种有效的微创手术方式,但远期疗效仍需要随访观察。

Objective To evaluate the effectiveness ofpercutaneous transforaminal endoscopic discectomy （PTED） combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation （LDH）. Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L4,5 in 30 cases and L5, S1 in 22 cases. In 30 patients at L4,5 level, there were 18 males and 12 females with an average age of 25 years （range, 18-34 years） and a mean disease duration of 10 months （range, 6-16 months）. In 22 patients at L5 S1 level, there were 10 males and 12 females with an average age of 25.5 years （range, 19-32 years） and a mean disease duration of 12 months （range, 6-18 months）. The operation time and intraoperative blood loss were recorded. Oswestry disability index （ODI） and Japanese Orthpoaedic Association （JOA） score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final foUow-up, including ventral intervertebral space height （VH）,dorsal intervertebral space height （DH）, intervertebral foramen height （IFH）, the range of motion （ROM） of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were （89.7±16.5） minutes and （42.7±11.3） mL in patients at L4,5 level, and were （94.6±18.2） minutes and （47.6±13.4） mL in patients at L5, S1 level. Incisions healed by first intention. All patients were followed up 12-18 months （mean,16 months） in patients at L5, S1 level and 12-20 months （mean, 17 months） in patients at L5 S1 level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients （P〈0.05）. X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients （P〈0.05）, and the ROM of involved segment was significantly reduced compared with preoperative one （P〈0.05）, but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one （P〉0.05）. Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.