经皮内镜下腰椎间盘切除术治疗复杂腰椎间盘突出症的临床效果分析

Analysis of the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of complex lumbar disc herniation

目的评价经皮内镜下腰椎间盘切除术(PELD)治疗复杂腰椎间盘突出症(LDH)的临床效果。方法回顾性分析2015年10月-2019年6月北京市垂杨柳医院骨科收治的行PELD的122例腰椎间盘突出症患者的临床病例资料。其中,男性71例,女性51例。根据腰椎间盘突出是否为单纯非游离型,分为对照组(n=85)和复杂组(n=37),对照组为单纯非游离型腰椎间盘突出症,复杂组包括游离型腰椎间盘突出症、中央型腰椎间盘突出症等情况。记录两组患者的年龄、住院时间、手术入路、手术时间、术中出血量、手术节段、围手术期并发症及术后3个月优良率。门诊复查随访3~36个月,术前、术后3 d、术后1个月及3个月采用Oswestry功能障碍指数(ODI)和改良MacNab标准评价手术效果。计量资料以均数±标准差(Mean±SD)表示,组间比较采用单因素ANOVA方差分析;计数资料以百分比(%)表示,组间比较采用χ2检验或者Fisher精确检验;等级分组资料组间比较采用Mann-Whitney U非参数检验。结果复杂组患者年龄[(63.0±15.9)岁]比对照组[(48.7±16.3)岁]偏大(t=2.289,P=0.030),复杂组患者住院时间[(13.0±6.9)d]比对照组[(8.2±4.3)d]也偏长,差异具有统计学意义(t=2.384,P=0.024)。两组手术入路比较,差异无统计学意义(χ2=0.420,P=0.517)。复杂组手术时间[(87.0±29.2)min]、出血量[(63.5±52.5)mL]与对照组相比[(59.0±25.0)min,16.3±10.9)mL],差异具有统计学意义[(t=2.737,P=0.011),(t=3.925,P=0.001)]。两组手术节段比较,差异无统计学意义(χ2=0.356,P=0.837)。复杂组手术相关并发症发生率(13.5%,5/37)明显高于对照组(2.4%,2/85),差异具有统计学意义(χ2=5.937,P=0.026)。术后3个月两组优良率比较差异无统计学意义(U=1398.000,P=0.106)。复杂组术前ODI评分[(86.6±8.8)分]明显高于对照组[(76.1±7.7)分],两组比较差异具有统计学意义(t=3.359,P=0.002)。术后两组ODI评分均出现明显下降,对照组术后3 d[(36.6±7.5)分]与术前[(76.1±7.7)分]相比,差异具有统计学意义(t=18.683,P=0.001);术后1个月[(15.0±10.8)分]与术后3 d[(36.6±7.5)分]相比,差异具有统计学意义(t=7.365,P=0.001);术后3个月[(10.4±12.7)分]与术后1个月[(15.0±10.8)分]相比,差异具有统计学意义(t=4.524,P=0.001)。复杂组术后3 d[(40.1±11.0)分]与术前[(86.6±8.8)分]相比,差异具有统计学意义(t=9.923,P=0.001);术后1个月[(18.2±15.1)分]与术后3 d[(40.1±11.0)分]相比,差异具有统计学意义(t=3.619,P=0.006);术后3个月[(12.7±14.5)分]与术后1个月[(18.2±15.1)分]相比,差异具有统计学意义(t=5.966,P=0.001)。结论PELD技术可治疗复杂类型LDH,与单纯非游离型LDH相比,尽管手术时间长、术中出血量多、术后并发症发生率高,但是术后ODI评分和优良率比较没有差别,与单纯非游离型LDH的临床效果相似。

Objective To evaluate the clinical effect of percutaneous endoscopic lumbar discectomy(PELD)in the treatment of complex lumbar disc herniation(LDH).Methods A retrospective analysis of clinical data of 122 patients with LDH who underwent PELD from October 2015 to June 2019 in department of orthopedics,Beijing Chui Yang Liu Hospital was performed.There were 71 males and 51 females.According to whether lumbar disc herniation was a simple non migrated type,the patients were divided into control group(n=85)and complex group(n=37).The age,length of stay,operative approach,operation time,the bleeding volume,operative segments,perioperative complications,and excellent and good rate of 3 months after operation were recorded.Follow-up visit was performed by regular outpatient visit for 3 to 36 months.Before and after surgery,3 days,1 month,and 3 months after surgery,the Oswestry disability index(ODI)and modified MacNab criteria were used to evaluate the effect of surgery.The measurement data were expressed as mean±standard deviation(Mean±SD),and the comparison between groups was performed by ANOVA analysis,the count data were expressed as percentage(%),and the comparison between groups was performed byχ2 test or Fisher test,the rank grouping data were performed by Mann-Whitney U non-parametric test.Results The age of patients in complex group[(63.0±15.9)years]was older than that in control group[(48.7±16.3 years](t=2.289,P=0.030),and the length of stay in complex group[(13.0±6.9)d]was longer than that in control group[(8.2±4.3)d](t=2.384,P=0.024).There were no significant differences of the operative approach between the two groups(χ2=0.420,P=0.517).Compared with the control group[(59.0±25.0)min,(16.3±10.9)mL],the operation time of the complex group[(87.0±29.2)min]was longer(t=2.737,P=0.011),and the bleeding volume[(63.5±52.5)mL]was more(t=3.925,P=0.001).There were no significant differences of the operative segments between the two groups(χ2=0.356,P=0.837).The incidence of operation related complications in the complex group(13.5%,5/37)was significantly higher than that in the control group(2.4%,2/85)(χ2=5.937,P=0.026).There were no significant differences in the excellent and good rate between the two groups at 3 months after operation(U=1398.000,P=0.106).The preoperative ODI score of the complex group[(86.6±8.8)scores]was significantly higher than that in the control group[(76.1±7.7)scores](t=3.359,P=0.002).The ODI score of the two groups decreased significantly.There were significant differences(t=18.683,P=0.001)between the preoperative[(76.1±7.7)scores]and 3 d postoperative[(36.6±7.5)scores]in the control group.There were significant differences(t=7.365,P=0.001)between the 3 d postoperative[(36.6±7.5)scores]and 1 month postoperative[(15.0±10.8)scores]in the control group.There were significant differences(t=4.524,P=0.001)between the 1 month postoperative[(15.0±10.8)scores]and 3 month postoperative[(10.4±12.7)scores]in the control group.There were significant differences(t=9.923,P=0.001)between the preoperative[(86.6±8.8)scores]and 3d postoperative[(40.1±11.0)scores]in the complex group.There were significant differences(t=3.619,P=0.006)between the 3d postoperative[(40.1±11.0)scores]and 1 month postoperative[(18.2±15.1)scores]in the complex group.There were significant differences(t=5.966,P=0.001)between the 1 month postoperative[(18.2±15.1)scores]and 3 month postoperative[(12.7±14.5)scores]in the complex group.Conclusions PELD technology can treat complex LDH.Compared with simple non migrated LDH,although the operation time is longer,the amount of intraoperative bleeding is more and the incidence of postoperative complications is higher,there is no difference in ODI scores,excellent and good rate.The clinical effect is similar to that of simple non migrated LDH.