经皮椎间孔镜下不同分型与PELD手术疗效的相关性分析

Analysis of the correlation between different types under percutaneous transforaminal endoscopy and the efficacy of PELD

目的分析经皮椎间孔镜下不同分型与经皮椎间孔镜下髓核摘除术(percutaneous transforaminal endoscopic discectomy,PELD)手术疗效的相关性。方法选取本院2017年3月~2018年11月收治的96例腰椎间盘突出症(lumbar intervertebral disc herniation,LDH)患者,均行PELD治疗,依据椎间孔镜下观察到的腰椎间盘及其和神经根的关系,将LDH分为压迫型、瘢痕型、钙化型与侧隐窝狭窄型等4种类型。比较不同类型的手术相关指标、腰部及下肢疼痛改善情况、功能受限改善情况、手术疗效。结果4种分型患者的手术时间、术中出血量与住院时间比较,差异无统计学意义(P>0.05);术后1年,压迫型、钙化型患者腰部VAS改善率显著高于瘢痕型与侧隐窝狭窄型(P<0.05),压迫型、瘢痕型、钙化型患者的下肢VAS评分改善率高于侧隐窝狭窄型(P<0.05),而压迫型、瘢痕型、钙化型三者组间无显著差异(P>0.05);压迫型、钙化型的ODI指数改善率显著高于侧隐窝狭窄型(P<0.05);4种分型的改良Macnab标准优良率比较,差异有显著性(P<0.05),其中压迫型、钙化型较高,分别为92.68%、94.44%,瘢痕型优良率一般(80.95%),侧隐窝狭窄型较差(62.50%)。结论PELD治疗LDH的效果与经皮椎间孔镜下分型有关。压迫型、钙化型进行PELD治疗后的腰痛及下肢放射痛均显著改善,且功能恢复情况及疗效均较优;瘢痕型下肢放射痛得到有效改善,功能恢复情况及术后疗效良好,但腰痛症状改善程度不佳;而侧隐窝狭窄型疼痛症状改善情况、功能恢复情况及术后疗效均差于上述三者。

Objective To analyze the correlation between different types under percutaneous transforaminal endoscopy and the efficacy of percutaneous endoscopic transforaminal lumbar discectomy(PELD).Methods From March 2017 to November 2018,96 patients with lumbar intervertebral disc herniation(LDH)admitted to our hospital were selected and treated with PELD.According to the relationship between lumbar intervertebral disc and nerve root observed under foramen microscopy,LDH was classified into four types:compression type,cicatricial type,calcification type and lateral recess stenosis type.The surgical related indicators,waist and lower extremity pain improvement,functional limitation improvement,surgical efficacy in different types were compared.Results There were no significant differences in operation time,intraoperative bleeding volume and hospitalization time among the four types of patients(P>0.05).At 1 year after operation,the improvement rate of waist VAS in compression type and calcification type was higher than that in cicatricial type and lateral recess stenosis type(P<0.05),the improvement rate of lower limb VAS score in compression type,cicatricial type and calcification type was higher than that in lateral recess stenosis type(P<0.05),but there was no significant difference among compression type,cicatricial type and calcification type(P>0.05).The improvement rate of ODI score in compression type and calcification type was higher than that in lateral recess stenosis type(P<0.05).There was a significant difference in the excellent and good rate of improved Macnab scores among four types(P<0.05),compression type and calcification type had higher excellent and good rate(92.68%and 94.44%),that of cicatricial type was 80.95%,and lateral recess stenosis type had lower excellent and good rate(62.50%).Conclusions The effect of PELD on LDH is related to the classification by percutaneous transforaminal microscopy.After PELD treatment,the symptoms of low back pain and radiation pain of lower extremities in compression type and calcification type are significantly improved,and the functional recovery and curative effect are better.Lower extremity radiation pain in cicatricial type has been effectively improved,functional recovery and postoperative efficacy are good,but the improvement of low back pain symptoms is not good.However,the improvement of pain symptoms,functional recovery and postoperative efficacy in lateral recess stenosis type are not as good as those in mentioned above.