探讨脊柱微创术中经皮椎间孔镜技术治疗腰椎间盘突出症对脊柱稳定性的影响

Exploration on the Effect of Percutaneous Intervertebral Foraminal Technique in the Treatment of Lumbar Disc Herniation on Spinal Stability during Minimally Invasive Spine Surgery

目的针对脊柱微创术中经皮椎间孔镜技术治疗腰椎间盘突出症的临床效果及对脊柱稳定性的影响进行探讨。方法纳入2019年3月—2020年3月46例腰椎间盘突出症患者为研究对象,以入院时间先后顺序对患者进行分组,并实施不同治疗方案,其中一组为对照组(n=23,后路椎板开窗髓核摘除手术治疗),另一组为观察组(n=23,经皮椎间孔镜技术治疗),对不同术式下患者的手术指标、腰椎功能恢复情况、疼痛程度、脊柱功能改善情况以及术后并发症发生情况进行比较。结果手术相关指标(手术切口长度、术中出血量、术后卧床时间、术后住院时间)比较,观察组低于对照组,差异有统计学意义(t=11.086、40.753、4.756、5.243,P<0.001);观察组腰椎功能恢复总有效率高于对照组,差异有统计学意义(χ^(2)=4.973,P=0.026);术后疼痛指标比较,术后15、30 d观察组VAS评分指标低于对照组,差异有统计学意义(t=6.026、8.793,P<0.001);脊柱功能指标比较,术后15、30 d观察组DOI指数评分指标低于对照组,差异有统计学意义(t=4.793、8.936,P<0.001);术后并发症发生率对比,观察组(4.34%)低于对照组(39.13%),差异有统计学意义(χ^(2)=6.261,P=0.012)。结论针对腰椎间盘突出症患者,实施经皮椎间孔镜技术治疗,对于降低手术对患者的创伤,减轻疼痛度,促进患者腰椎功能恢复,稳定患者的脊柱功能作用显著,方案值得推荐。

Objective To discuss the clinical effect of percutaneous foraminal endoscopy in the treatment of lumbar disc herniation and its influence on spinal stability during minimally invasive spinal surgery.Methods Forty-six patients with lumbar disc herniation from March 2019 to March 2020 were enrolled in the study.The patients were grouped according to the order of admission,and different treatment regimens were implemented.One group was the control group(n=23,posterior laminectomy discectomy),and the other group was the observation group(n=23,percutaneous transforaminal endoscopic treatment).The surgical indexes,lumbar function recovery,pain degree,spinal function improvement and postoperative complications were compared under different surgical methods.Results The operation-related indicators(operative incision length,intraoperative blood loss,postoperative bed time,and postoperative hospital stay)in the observation group were lower than those in the control group,and the differences were statistically significant(t=11.086,40.753,4.756,5.243,P<0.001).The total effective rate of lumbar function recovery in the observation group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.973,P=0.026).Compared with the postoperative pain indexes,the VAS scores in the observation group at 15 d and 30 d after operation were lower than those in the control group,and the differences were statistically significant(t=6.026,8.793,P<0.001).Compared with the spinal function indexes,the DOI index scores in the observation group at 15 d and 30 d after operation were lower than those in the control group,and the differences were statistically significant(t=4.793,8.936,P<0.001).The incidence of postoperative complications in the observation group(4.34%)was lower than that in the control group(39.13%),and the difference was statistically significant(χ^(2)=6.261,P=0.012).Conclusion For patients with lumbar disc herniation,the implementation of percutaneous intervertebral foraminal technology treatment can reduce the trauma of the operation to the patient,reduce the pain,promote the recovery of the patient's lumbar function,and stabilize the patient's spine function.The program is worth recommending.