经皮椎间孔镜下髓核摘除术治疗青少年腰椎间盘突出症的疗效及对腰椎功能的影响

Effect of percutaneous transforaminal endoscopic discectomy on lumbar disc herniation in adolescents and its impact on lumbar spine function

目的比较经皮椎间孔镜下髓核摘除术和经后路椎板间开窗髓核摘除术治疗青少年腰椎间盘突出症的疗效及对腰椎功能的影响。方法选取2014年1月至2018年12月上海市松江区中心医院、河南省洛阳正骨医院、复旦大学附属金山医院收治的青少年腰椎间盘突出症患者90例,按照手术方式不同分为观察组和对照组,每组45例。对照组予以经后路椎板间开窗髓核摘除术,观察组予以经皮椎间孔镜下髓核摘除术。观察两组疗效并对两组治疗前后切口长度、术中出血量、手术时间、下床活动时间和术后住院时间进行比较,以及分析两组治疗前后腰痛视觉模拟评分(VAS)、腿痛VAS、日本矫形外科协会(JOA)评分、硬膜外压痕、Oswesry功能障碍指数(ODI)、Cobb角、腰椎前屈和腰椎后伸水平变化。结果观察组总有效率为91.11%,对照组总有效率为71.11%,观察组总有效率明显优于对照组,差异有统计学意义(χ^(2)=4.641,P<0.05)。观察组切口长度、术中出血量、手术时间、下床活动时间和术后住院时间明显少于或者短于对照组,差异均有统计学意义(P<0.05)。两组治疗前腰痛VAS、腿痛VAS、JOA评分、硬膜外压痕、ODI、Cobb角、腰椎前屈和腰椎后伸水平比较,差异均无统计学意义(P>0.05)。两组治疗后腰痛VAS、腿痛VAS、硬膜外压痕、ODI和Cobb角较治疗前明显降低,而JOA评分、腰椎前屈和腰椎后伸水平较治疗前明显升高,差异均有统计学意义(P<0.05)。结论经皮椎间孔镜下髓核摘除术对青少年腰椎间盘突出症的疗效显著,明显优于经后路椎板间开窗髓核摘除术,具有创伤小、恢复快等优势,有助于患者腰椎功能恢复。

Objective To compare the effect of percutaneous transforaminal endoscopic discectomy and posterior interlaminar nucleus pulposus removal for the treatment of lumbar disc herniation in adolescents and its impact on lumbar spine function.Methods 90 patients with lumbar disc herniation were enrolled in Songjiang District Central Hospital,Luoyang Zhenggu Hospital and Jinshan Hospital,Fudan University from January 2014 to December 2018,were divided into observation group and control group according to different surgical methods,with 45 cases in each group.The control group underwent posterior interlaminar nucleus pulposus removal.The observation group underwent percutaneous transforaminal endoscopic discectomy.The efficacy of the two groups were observed,and the incision length,intraoperative blood loss,operative time,ambulation time and postoperative hospitalization time were compared between the two groups before and after treatment.The visual analog scale(VAS)of low back pain,leg pain VAS,Japanese Orthopedic Association(JOA)score,epidural indentation,Oswesry dysfunction index(ODI),Cobb angle,lumbar flexion and lumbar extension were analyzed before and after treatment.Results The total effective rate was 91.11%in the observation group,and 71.11%in the control group,the total effective rate in the observation group was significantly better than that in the control group,the difference was statistically significant(χ^(2)=4.641,P<0.05).The length of the incision,intraoperative blood loss,operation time,ambulation time,and postoperative hospi-talization time were significantly less or shorter than those in the control group,the difference was statistically significant(P<0.05).There were no significant differences of low back pain VAS,leg pain VAS,JOA score,epidural indentation,ODI,Cobb angle,lumbar spine flexion and lumbar spine extension before treatment(P>0.05).The low back pain VAS,leg pain VAS,epidural indentation,ODI and Cobb angle were significantly lower than those before treatment,the JOA score,lumbar flexion and lumbar extension were significantly higher than before treatment,the difference was statistically significant(P<0.05).Conclusion Percutaneous transforaminal endoscopic excision of nucleus pulposus has a significant effect on adolescent lumbar disc herni-ation,which is obviously superior to posterior interlaminar nucleus pulposus removal,with advantages of less trauma and faster recovery,and is helpful to the recovery of lumbar spine function.