CT引导脊柱内镜治疗高度脱垂型腰椎间盘突出症的对照研究

Comparative study of the treatment of highly migrate lumbar disc herniation under CT-guided percutaneous endoscopic discectomy

目的:评估CT引导经皮脊柱内镜(Percutaneous endoscopic lumbar discectomy,PELD)治疗高度脱垂型腰椎间盘突出症的疗效与安全性。方法:选取2016年8月至2019年12月因腰腿痛就诊于我院疼痛科或脊柱外科门诊,且最终诊断为高度脱垂型腰椎间盘突出症患者88例,分别行CT引导经皮脊柱内镜手术(CT-PELD组)和后路开放椎间盘摘除术(OD组)。应用数字模拟评分(Numerical rating scale,NRS)评估两组患者术前、术后1周、术后3月、术后6月、术后12月和末次随访疼痛变化,应用改良MacNab疗效评定标准评估两组患者术后优良率,记录术中及围手术期并发症及复发情况。结果:与术前相比,两组手术患者术后各时间段NRS评分明显降低,差异有统计学意义(P<0.01);组间比较,除术后1周OD组患者疼痛NRS评分高于CT-PELD组(P<0.01),两组术前及术后各时间点NRS评分差异无统计学意义(P>0.05);术后12月OD组和CT-PELD组的疗效优良率分别为87.8%、91.5%,差异无统计学意义(P>0.05);OD组住院费用较CT-PELD组更低,手术时间更短,但住院天数更长,差异均有统计学意义(P<0.05)。结论:依据个体化选择手术方案,CT-PELD可有效治疗高度脱垂型腰椎间盘突出症,且安全性较好。

Objective:To evaluate the efficacy and safety of Percutaneous endoscopic lumbar discectomy via computed tomography(CT)-guided surgery in the treatment of highly migrate lumbar disc herniation.Methods:From August 2016 to December 2019,a total of 88 patients with lumbar and leg pain who were randomly admitted to the pain department or spinal surgery outpatient department of the First Affiliated Hospital of Gannan Medical University,and fin-ally diagnosed as highly migrate lumbar disc herniation.They were divided into CT-guided Percutaneous endoscopic lumbar discectomy(CT-PELD group)and open discectomy(OD group)according to the operation method.To evaluate the surgical treatment effect,comparison was done between the two group patie-nts with the Numerical rating scale(NRS)of preoperatively and postoperatively(postoperative 1 weeks,3 months,6 months,12 months and the last follow-up),respectively,also the postoperative excellent and good rates of patients at 12 months by the modified MacNAB efficacy assessment criteria,perioperative complications and recurrence and time of operation、hospitalization expense were recorded.Results:Compared with preoperation,the NRS scores of patients in both groups were significantly decreased at each time perio-d after operation,with statistical significance(P<0.01).There was no significant difference in preoperative and postoperative NRS scores between the two groups(P>0.05).The excellent and good efficacy rates of OD group and CT-PELD group were 87.8%and 91.5%,respectively,12 months after operation,and there was no significant difference(P>0.05).The cost of hospitalization and time of opera-tion in OD is lower than that in CT-PELD,but longer hospital stays in OD,and the difference was statistically significant(P<0.05).Conclusion:The surgical plan is selected according to the principle of individuation,CT-PELD can effectively treat highly migrate lumbar disc herniation,and it is safer.