内镜椎间盘切除联合激素治疗L_(5)S_(1)椎间盘脱出症

Percutaneous endoscopic lumbar discectomy combined with glucocorticoid for prolapsed L_(5)S_(1) disc herniation

[目的]探讨经皮脊柱内镜下椎间盘切除术(percutenous endoscopic lumbar discectomy,PELD)联合激素(glucocorti-coid,GC)治疗L_(5)S_(1)椎间盘脱出症的疗效.[方法]回顾性分析本院2015年6月-2019年1月PELD治疗的单纯L_(5)S_(1)椎间盘脱出症116例患者的临床资料.根据医患沟通结果,40例于PELD手术结束时硬膜外注射复方倍他米松,42例术后予以静脉滴注甲强龙,34例不使用GC.比较三组围手术期、随访和影像资料.[结果]三组患者均顺利完成手术,无严重并发症.三组患者切口长度、术中出血量以及手术时间的差异均无统计学意义(P>0.05).术后1、7 d NRS评分由低至高依次为:硬膜外组<静脉组<空白对照组(P<0.05);而JOA评分由高至低依次为:硬膜外组>静脉组>空白对照组,差异均有统计学意义(P<0.05).与术前相比较,术后3个月和末次随访时三组患者NRS评分、ODI评分均显著下降(P<0.05),而JOA评分显著增加(P<0.05).相应时间点,三组间NRS、ODI和JOA评分的差异均无统计学意义(P>0.05).影像方面,与术前相比较,末次随访时三组患者椎管面积均显著增加(P<0.05),而椎间隙高度均无显著变化(P>0.05).相应时间点,三组间椎管面积和椎间隙高度的差异均无统计学意义(P>0.05).[结论]采用PELD联合GC治疗L_(5)S_(1)椎间盘脱出症可显著改善早期临床结果.

[Objective]To explore the clinical efficacy of percutenous endoscopic lumbar discectomy(PELD)combined with glucocorticoid(GC)for L_(5)S_(1) prolapsed disc herniation.[Methods]A restrospective study was done on 116 patients who underwent PELD for L5S1 prolapsed disc herniation in our hospital from June 2015 to January 2019.According to doctor-patient communication results,40 patients re-ceived epidural injection of compound betamethasone at the end of surgery(the epidural group),42 patients received intravenous infusion of methylprednisolone after surgery(the intravenous group),whereas no GC was used in the other 34 patients(the blank control group).Perioperative,follow-up and imaging data were compared among the three groups.[Results]All patients in the three groups were successfully operated on without serious complications.There were no significant differences in incision length,intraoperative blood loss and operative time among the three groups(P>0.05).At Id and 7d after surgery,NRS scores ranked down-up in order as epidural group<venous group<blank control group(P<0.05),conversely,JO A score arragged up-down as epidural group>venous group>blank control group,the differences were statistically significant(P<0.05).The NRS scores and ODI scores significantly decreased(P<0.05),while JOA score increased significantly at 3 months after surgery and the latest follow-up compared with those before surgery in all the 3 groups(P<0.05).At any corresponding time point,there were no significant differences in NRS,ODI and JOA scores among the three groups(P>0.05).Radiographically,the spinal canal area was significantly increased(P<0.05),whereas the intervertebral height remained unchanged in all three groups at the last follow-up compared with those preoperatively(P>0.05).At corresponding time points,there were no significant differences in spinal canal area and intervertebral space height among the three groups(P>0.05).[Conclusion]PELD combined with GC does significantly improve the early clinical outcome for L5S1 prolapsed disc herniation.