Quadrant工作通道下髓核摘除术联合纤维环缝合治疗青少年腰椎间盘突出症的疗效分析

Analysis of the curative effect of discectomy under Quadrant expandable channel associated with annulus repair for the treatment of adolescent lumbar disc herniation

目的探讨Quadrant工作通道下髓核摘除术联合纤维环缝合治疗青少年腰椎间盘突出症(ALDH)的临床疗效。方法回顾性收集2013年1月至2017年12月扬州大学临床医学院通过Quadrant工作通道下实施髓核摘除手术联合纤维环缝合手术治疗的10例ALDH患者(纤维环缝合组),以及髓核摘除手术治疗的12例ALDH患者(对照组)的临床资料,比较两组切口长度、术中出血量、手术时间及术后住院时间,术前、术后24 h、1周及1年以视觉模拟量表评分(VAS)评估疼痛程度,术前、术后1周及1年以Oswestry功能障碍指数(ODI)评估腰椎功能。末次随访时通过MacNab量表评估疗效,同时记录随访过程中腰椎间盘突出症的复发情况。结果与对照组比较,纤维环缝合组切口长度略短(P<0.05);两组手术时间、术中出血量及术后住院时间比较,差异无统计学意义(P>0.05);两组术后VAS及ODI评分均较术前明显改善(P<0.05),纤维环缝合组术后24 h的VAS评分低于对照组(P<0.05),但两组间术后1周、1年的VAS评分及术后ODI评分比较,差异无统计学意义(P>0.05)。纤维环缝合组优良率9/10,对照组优良率10/12,两组比较差异无统计学意义(P>0.05)。纤维环缝合组术后无复发病例,对照组有2例共2个节段术后复发,复发率2/12,两组比较差异有统计学意义(P<0.05)。结论Quadrant工作通道下髓核摘除手术联合纤维环缝合手术治疗青少年腰椎间盘突出症的早期临床疗效满意,可以进一步减少手术创伤,减轻术后早期疼痛,同时一定程度上可有效降低腰椎间盘突出症的术后复发率。

Objective To analyze the curative effect of discectomy under Quadrant expandable channel associated with annulus repair for the treatment of adolescent lumbar disc herniation(ALDH).Methods 10 ALDH patients received discectomy under Quadrant expandable channel associated with annulus repair(annulus repair group)and 12 patients received discectomy(control group)in Clinical Medical College of Yangzhou University from January 2013 to December 2017 were retrospectively collected.The length of skin incision,amount of intraoperative bleeding,operation time and duration of hospitalization were compared.The degree of pain was assessed by visual analogue scale(VAS)before operation,24 h,1 week and 1 year after operation,and the lumbar function was assessed by Oswestry disability index(ODI)before operation,1 week and 1 year after operation.At the last follow-up,the curative effect was evaluated by MacNab Scale,and the recurrence of lumbar disc herniation during the follow-up was recorded.Results There were no significant differences in the amount of intraoperative bleeding,operation time and duration of hospitalization between the two groups(P>0.05).The skin incision length of the annulus repair group was less than that of control group(P<0.05).The postoperative VAS score and ODI score at each follow up time point in both groups were significantly improved when compared with the preoperative ones(P<0.05).There were no statistically significant difference between the two groups in the VAS score and ODI score 1 week postoperative and 1 year postoperative(P>0.05).According to the MacNab criteria,there was no statistically significant difference between the two groups in the excellent and good rate(annulus repair group:9/10,control group:10/12;P>0.05).There was no recurrence case in the annulus repair group,but two cases of recurrence(one recovered by conservative treatment,the other needed second operation)in the control group(P<0.05).Conclusions Discectomy under Quadrant expandable channel associated with annulus repair can achieve early satisfied outcome,reduce surgery related trauma,pain in the early period postoperative and recurrence rate after operation in the treatment of ALDH.