脊柱内镜下不同入路椎间盘摘除术治疗胸腰段椎间盘突出症疗效对比

Discectomies from Different Approaches under the Spinal Endoscopy in the Treatment of Thoracolumbar Disc Herniation

目的回顾性对比分析脊柱内镜下不同入路椎间盘摘除术治疗胸腰段椎间盘突出症的临床疗效。方法选取2015年4月至2018年4月中国人民解放军联勤保障部队第九八八医院收治的48例胸腰段椎间盘突出症患者作为研究对象,并将采用脊柱内镜下经椎板间入路椎间盘摘除术治疗的24例患者设为椎板间入路组,脊柱内镜下经椎间孔入路椎间盘摘除术治疗的24例患者设为椎间孔入路组,对比两组患者手术时间、随访时间、并发症发生情况、视觉模拟评分法(visual analogue scale,VAS)评分及日本骨科协会(Japanese Orthopaedic Association,JOA)评分改善情况。结果 (1)两组患者均顺利完成手术及12个月以上随访,手术时间及随访时间无明显差异(t=0.686、0.625,P=0.496、0.535)。(2)术后,椎板间入路组并发硬膜囊撕裂者明显多于椎间孔入路组(χ~2=4.364,P=0.037),而神经根损伤、下肢麻木及复发情况无明显差异(χ~2=0.000、0.356、0.000,P=1.000、0.551、1.000)。(3)术后1d及末次随访时,两组患者VAS评分均较术前明显降低(P均<0.05),但两组间无明显差异(t=0.443、0.563,P=0.660、0.576)。(4)术后3个月及末次随访时,两组患者JOA评分均较术前明显升高(P均<0.05),但两组间无明显差异(t=1.193、1.105,P=0.239、0.275)。结论在脊柱内镜下经椎板间入路及椎间孔入路行椎间盘摘除术均可有效缓解胸腰段椎间盘突出症患者的症状及体征,疗效均较显著,但椎板间入路组患者硬膜囊撕裂发生率明显高于椎间孔入路组,临床治疗中应综合患者具体情况择优选择。

Objective To retrospectively analyze and compare the clinical efficacy of discectomies from different surgical approaches under the spinal endoscopy in the treatment of thoracolumbar disc herniation.Methods Forty-eight patients with thoracolumbar disc herniation admitted into the Chinese PLA Integrated Logistic Support Force 988 th Hospital between April 2015 and April 2018 were selected as study subjects,of which 24 patients underwent discectomy from the interlaminar approach under the spinal endoscopy were set as the interlaminar approach group and the other 24 patients received discectomy from the intervertebral foramen approach were set as the intervertebral foramen approach group.The following indicators,including operation time,follow-up time,occurrence of complications,visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)score were compared between the two groups.Results(1)The patients in the two groups all have completed the operation and twelve-month follow-up,and there was no significant difference between the two groups in terms of operation time and follow-up time(t=0.686 and 0.625,P=0.496 and 0.535).(2)After the operation,patients developed the complication of dural sac avulsion in the interlaminar approach group were obviously more than that in the intervertebral foramen approach group(χ~2=4.364,P=0.037),while no significant difference was observed between the two groups in terms of nerve root damage,lower limb numbness and relapse(χ~2=0.000,0.356 and 0.000 respectively,P=1.000,0.551 and 1.000 respectively).(3)On day 1 post-operation and during the last follow-up,the VAS scores were markedly decreased as compared to that before the operation in the two groups(P<0.05),but there was no significant difference between the two groups(t=0.443 and 0.563,P=0.660 and 0.576).(4)On month 3 post-operation and during the last follow-up,the JOA scores in the two groups were obviously increased compared with that before the operation(P<0.05),and also there was no significant difference between the two groups(t=1.193 and 1.105,P=0.239 and 0.275).Conclusion No matter it is from the interlaminar approach or from the intervertebral foramen approach,discectomy under the spinal endoscopy can effectively relieve the symptoms and vital signs of patients with thoracolumbar disc herniation,and the curative effects of the two approaches were significant.But the incidence of dural sac avulsion in patients underwent the discectomy from the interlaminar approach is much higher than that in the intervertebral foramen approach,and thus the choice of which approach to take in clinical practice should be decided based on the specific condition of patients.