经椎间孔入路经皮内窥镜下腰椎椎间盘切除术治疗腰椎椎间盘突出症的疗效及预后影响因素分析

Percutaneous endoscopic transforaminal discectomy for lumbar disc herniation:clinical efficacy and prognostic factor analysis

目的探讨经椎间孔入路经皮内窥镜下腰椎椎间盘切除术(PETD)治疗腰椎椎间盘突出症(LDH)的临床疗效,并探讨影响患者预后的相关因素。方法采用前瞻性队列研究设计,纳入2015年8月—2016年9月诊断为LDH并行PETD治疗的102例患者。分别于术前1 d及术后1 d、3个月、6个月、12个月、36个月时评估疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)评分,采用改良MacNab标准评估临床疗效。分析患者临床特征和影像学资料等因素对预后的影响。结果86例患者完成36个月及以上随访,其中男56例、女30例,年龄19~88(46.96±14.03)岁,随访36~46(40.91±3.21)个月。86例患者手术顺利完成,无术中转开放手术。并发症发生率为1.2%(1/86),复发率为5.8%(5/86)。术后1 d、3个月、6个月、12个月、36个月,腰痛和腿痛VAS评分及ODI均较术前下降,JOA评分较术前升高,差异均有统计学意义(P<0.05)。根据改良MacNab标准,术后36个月优良率为94.2%(81/86)。突出髓核(HNP)越大,术后腿痛VAS评分、ODI和JOA评分改善越明显,差异有统计学意义(P<0.05);与体质量指数(BMI)<25 kg/m^2的患者相比,BMI≥25 kg/m^2的患者JOA评分改善较小,差异无统计学意义(P>0.05)。结论PETD治疗LDH可取得满意疗效。HNP大小是影响患者预后的主要因素,BMI可能对预后也有一定影响,但尚需扩大样本量进一步研究。

Objective To investigate the clinical efficacy of percutaneous endoscopic transforaminal discectomy(PETD)for lumbar disc herniation(LDH),and explore the related factors affecting the prognosis.Methods The study design was a prospective study.From August 2015 to September 2016,102 patients diagnosed as LDH and treated with PETD were included.The low back and leg pain visual analogue scale(VAS)score,Oswestry disability index(ODI)and Japanese Orthopedic Association(JOA)score were evaluated at preoperative 1 d,postoperative 1 d and 3,6,12,36 months.The modified MacNab criteria was used to evaluate the clinical efficacy.The influences of clinical features and imaging data on prognosis were analyzed.Results There were 86 patients with complete follow-up data for 36 months,including 56 males and 30 females,aged 19-88(46.96±14.03)years old,and the follow-up period was 36-46(40.91±3.21)months.The operation was successfullycompleted in 86 patients without conversion to open surgery.The complication rate was 1.2%(1/86),the recurrence rate was 5.8%(5/86).At postoperative 1 d and 3,6,12,36 months,VAS score of low back and leg pain and ODI were decreased compared with those before operation,while JOA score was higher than that before operation,all with a statistical significance(P<0.05).According to the modified MacNab criteria,excellent and good outcome rate was 94.2%(81/86)at postoperative 36 months.The larger the size of herniation nucleus pulposus(HNP),the more obvious the improvement of VAS score,ODI and JOA score of patients after operation(P<0.05).Compared with patients with body mass index(BMI)<25 kg/m^2,JOA score of patients with BMI≥25 kg/m^2 improved slightly,but the difference was not statistically significant(P>0.05).Conclusion PETD can achieve good outcome for LDH.The size of HNP is the main factor affecting the prognosis of patients.BMI may also have a certain impact on the prognosis,but the sample size needs to be expanded for further study.