侧路单次环锯椎间孔成形技术在治疗腰椎间盘突出症的临床观察研究

Clinical application of single-ring saw disposable intervertebral foramen in the treatment of lumbar disc herniation with intervertebral foramen

目的观察利用大直径单次环锯(第三级环锯)侧路一次性椎间孔成形技术在椎间孔镜治疗腰椎间盘突出症中的临床疗效。方法采用倾向评分挑选基线资料匹配的患者共60例进行回顾性分析,按照手术方式将患者分为三级环锯组和单次环锯组。三级环锯组采用逐级环锯(绿色、黄色和红色环锯)依次扩大椎间孔,单次环锯组椎间孔成形采用大直径第三级环锯(红色环锯)一次性成形技术。比较两组患者椎间孔成形时间、手术时间、术中出血量、术中透视次数、手术总时间,手术前后及末次随访的腰腿痛VAS评分、腰椎Oswestry功能障碍指数(ODI),末次随访采用MacNab标准评价疗效。结果观察组术中椎间孔成形时间、术中出血量、术中透视次数、手术总时间均显著少于对照组,差异均有统计学意义(P<0.01)。两组间术后VAS、ODI指数差异无统计学意义(P>0.05);两组患者术后6个月MacNab疗效评价优良率差异无统计学意义(P>0.05)。结论大直径单次环锯侧路一次性椎间孔成形技术治疗腰椎间盘突出症,能够明显减少椎间孔成形的操作步骤及难度、缩短椎间孔成形及手术时间,减少医护人员及患者X线暴露次数,术后疗效确切,值得临床推广。

Objective To observe the clinical application of large-diameter single-ring saw(the third-stage ring saw)one-time intervertebral foramen technique in the treatment of lumbar disc herniation with intervertebral foramen.Methods A total of 60 patients with matched baseline data were selected for retrospective analysis using the propensity score method.The patients were divided into a three-stage ring saw group and a single ring saw group according to the surgical method.The three-stage ring saw group used progressive ring saws(green,yellow and red ring saws)to expand the intervertebral hole in turn.The single-time ring saw group used a large-diameter third-stage ring saw(red ring saw)for one-time forming.The time of transforaminal foramen formation,operation time,intraoperative blood loss,intraoperative fluoroscopy times,total operation time,VAS score of low back and leg pain before and after operation and at the last follow-up,lumbar Oswestry disability index(ODI)were compared between the two groups.MacNab standard was used to evaluate the curative effect at the last follow-up.Results The time of intervertebral foramen formation,intraoperative blood loss,intraoperative fluoroscopy and total operation time in the observation group were significantly lower than those in the control group.The differences were statistically significant(P<0.01).There were no significant differences in postoperative VAS and ODI scores between the two groups(P>0.05).There was no significant difference in the excellent rate of MacNab between the two groups(P>0.05).Conclusion Large-diameter single-ring saw disposable intervertebral foramen formation for lumbar disc herniation can significantly reduce the operation and difficulty of intervertebral foramen formation,shorten the formation of intervertebral foramen and operation time,and reduce X-ray exposure of medical staff and patients.The number of times,the curative effect is exact,and it is worthy of clinical promotion.