经皮椎间孔镜治疗青少年腰椎间盘突出症近期疗效分析

Short-term efficacy of percutaneous transforaminal lumbar discectomy in the treatment of adolescent lumbar disc herniation

目的应用经皮椎间孔镜技术对患有青少年腰椎间盘突出症(adolescent lumbar disc herniation,ALDH)的患者施行手术治疗,探讨该技术对青少年患者责任椎间隙高度、脊柱稳定的影响,并观察其近期临床疗效。方法选取2013年7月-2019年3月在我院接受经皮椎间孔镜手术治疗的腰椎间盘突出症青少年患者(年龄≤21岁)共45例。术前、术后(术后1天、3个月、6个月)分别在我院Vue PACS影像评估测量系统测量以下指标:椎间隙高度(腰椎正侧位)、脊柱矢状位上椎体间位移(AO或RO)及椎间成角(θ)(腰椎过伸过屈位);并应用视觉疼痛模拟评分(visual analogue scale,VAS)、功能障碍指数(oswestry disability index,ODI)和改良MacNab对手术疗效进行评价。结果在术前、术后1天、术后3个月、术后6个月对患者进行随访。椎间隙高度随着随访时间的延长逐渐降低,在术后3个月、术后6个月与术前相比较有统计学差异(P<0.05);脊柱矢状位上椎体间位移(AO或RO)及椎间成角(θ)在不同随访时间点相比较统计学无显著差异(P>0.05);VAS、ODI评分,术后1天与术前相比较具有统计学意义(P<0.05),且术后随着随访时间的延长,VAS、ODI评分呈降低趋势;改良MacNab评价标准优良率为84.4%。结论经皮椎间孔镜技术治疗ALDH可取得较好的疗效,对患者椎间隙高度、脊柱稳定性无显著影响。

Objective The postoperative operation on the height of intervertebral space and stability of the spine in adolescents and recent clinical observations were investigated in the surgical treatment with percutaneous transforaminal technique for adolescent lumbar disc herniation(ALDH)patients.Methods A total of 45 adolescents(age≤21 years old)with lumbar disc herniation who underwent percutaneous transforaminal surgery in our hospital from July 2013 to May 2019 were enrolled.Before and after the surgery(1 day,3 months,and 6 months after surgery),the following indicators were measured on our Vue PACS:intervertebral space height(positive lateral position of the lumbar vertebrae)and intervertebral displacement between the sagittal planes of the spine(AO or RO)and intervertebral angle(θ)(lumbar hyperextension and overflexion).The visual analogue scale(VAS),Oswestry disability index(ODI)and modified MacNab were used to evaluate the curative effect.Results Patients were followed up before surgery,1 day,3 months and 6 months after surgery.There was no significant difference in the height of the intervertebral space,the intervertebral displacement(AO or RO)and the intervertebral angle(θ)in the sagittal position of the spine at different follow-up times(P>0.05).The“VAS”and“ODI”scores were used to evaluate the postoperative outcomes of the patients.The preoperative and postoperative rates were statistically significant(P<0.05),and the postoperative follow-up time was extended,“VAS”and“ODI”.The score is decreased.According to the improved MacNab evaluation criteria,the excellent and good rate was 84.4%.Conclusion Percutaneoustransforaminal technique is a good treatment for ALDH,and recent follow-up findings have no significant effect on the height of the intervertebral space and the stability of the spine.