经皮椎间孔镜技术治疗腰椎内固定术后邻近节段椎间盘突出的临床疗效分析

The effect of the THESSYS technique on adjacent segment lumbar intervertebral disc herniation after lumbar internal fixation

目的探讨经椎间孔内窥镜(THESSYS)技术治疗腰椎内固定术后邻近节段椎间盘突出的临床疗效。方法回顾性分析腰椎内固定术后邻近节段椎间盘突出患者共63例,按照手术方式随机分为治疗组(31例)和对照组(32例),治疗组采用微创椎间孔镜下髓核摘除术治疗,对照组采用开放手术进行手术治疗,比较两组手术时间、手术切口、住院时间、术后腰痛VAS评分、术后下肢放射痛VAS评分、术后Oswestry功能障碍指数(ODI)差异。结果与对照组比较,治疗组手术切口更小[(0.91±0.17)cm vs.(8.48±0.65)cm]、手术时间更短[(45.00±9.85)min vs.(82.71±7.02)min]、住院时间更短[(4.96±1.07)d vs.(9.66±1.96)d],差异有统计学意义(P<0.05);治疗组术后腰痛VAS评分,术后ODI指数均较对照组有优势,差异有统计学意义(P<0.05),两组下肢放射痛VAS评分比较差异无统计学意义(P>0.05)。结论 THESSYS技术治疗腰椎内固定术后邻近节段椎间盘突出的临床疗效确切,手术切口小、手术时间短、住院时间短,出血少,能有效避开原内固定,避免延长融合节段,并减少因剥离椎旁肌造成的腰痛,值得临床推广与应用。

Objective To investigate the clinical effect of the endoscopic lumbar discectomy ( THESSYS) technique on the treatment of lumbar intervertebral disc herniation at adjacent segment after lumbar internal fixation. Methods Sixty-three cases of lumbar disc herniation at adjacent segments after lumbar internal fixation from January 2013 to December 2018 in Foshan Hospital of Traditional Chinese Medicine were analyzed. The patients were randomly divided into the treatment group ( 31 cases) and the control group ( 32 cases). The treatment group was treated with THESSYS and the control group was treated with open operation. Comparison in operative time,operative incision,hospital stay,postoperative low back pain VAS score,postoperative lower limb radiative pain VAS score,and postoperative ODI index were performed. Results As compared with those in control group,significantly smaller operative incision [( 0. 91 ± 0. 17) cm vs.( 8. 48 ± 0. 65) cm],and shorter operative time [( 45. 00 ± 9. 85) min vs.( 82. 71 ± 7. 02) min]and the hospital stay [( 4. 96 ± 1. 07) d vs.( 9. 66 ± 1. 96) d]were revealed in the treatment group ( P < 0. 05). The VAS score and ODI index of low back pain in the treatment group was significantly reduced comparing with control group ( P < 0. 05),though there was no significant difference in the VAS score of radiating pain of lower extremities between the two groups ( P > 0. 05). Conclusion The THESSYS technique is effective in the treatment of lumbar disc herniation in adjacent segments after internal fixation,providing small incision,short operation time,short hospital stay and little blood loss,can effectively avoid prolonging the fusion segments,and reduce the lumbago caused by stripping the paraspinal muscles.