两种手术方式治疗不同Pfirrmann分级腰椎间盘突出症的疗效分析

Efficacy analysis of two surgical methods in the treatment of lumbar disc herniation with different Pfirrmann grades

目的 探讨后路腰椎椎间融合术(Posterior lumbar interbody fusion,PLIF)与经皮椎间孔镜腰椎髓核摘除术(Percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症的临床疗效,分析Pfirrmann分级对腰椎间盘突出症手术方式选择的指导意义。方法 回顾性分析自2016-08—2018-03诊治的136例腰椎间盘突出症,69例采用PTED治疗(微创组),67例采用PLIF治疗(开放组),比较两组手术时间、术中出血量、住院时间,比较两组PfirrmannⅡ级、Ⅲ级、Ⅳ级腰椎间盘突出症术后1个月、1年的腰痛VAS评分、腿痛VAS评分、ODI指数以及末次随访时的SF-12 PCS评分。结果 两组均顺利完成手术并获得至少12个月的随访,微创组手术时间、术中出血量、住院时间较开放组少,差异有统计学意义(P<0.05)。术后1个月微创组PfirrmannⅡ级、Ⅲ级腰椎间盘突出症腰痛VAS评分、ODI指数较开放组低,差异有统计学意义(P<0.05)。术后1个月微创组PfirrmannⅣ级腰椎间盘突出症腰痛VAS评分、ODI指数较开放组低,差异有统计学意义(P<0.05)。术后1年微创组PfirrmannⅣ级腰椎间盘突出症腰痛VAS评分、腿痛VAS评分、ODI指数较开放组高,差异有统计学意义(P<0.05)。末次随访时微创组PfirrmannⅢ级腰椎间盘突出症SF-12 PCS评分较开放组高,微创组PfirrmannⅣ级腰椎间盘突出症SF-12 PCS评分较开放组低,差异有统计学意义(P<0.05)。结论 Pfirrmann分级与不同手术方式治疗腰椎间盘突出症的术后疗效之间有着密切关系,PTED具有损伤小、手术时间短、术中出血少等特点,对于PfirrmannⅡ级、Ⅲ级腰椎间盘突出症具有较好的临床疗效;PLIF具有病变椎间盘摘除彻底、椎间融合稳定等特点,对于PfirrmannⅣ级腰椎间盘突出症具有较好的长期疗效。

ObjectiveTo investigate the efficacy of posterior lumbar interbody fusion(PLIF) and percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation and analyze the guiding significance of Pfirrmann grading in the selection of surgical methods for lumbar disc herniation.MethodsA retrospective analysis was performed on136 cases of lumbar disc herniation treated from August 2016 to March 2018, including 69 cases treated with PTED(minimally invasive group) and 67 cases with PLIF(open group). Operation time, intraoperative blood loss and hospital stay were compared between the two groups. The low back pain VAS score, leg pain VAS score, ODI index at 1 month and 1 year after operation and SF-12 PCS score at the last follow-up of Pfirrmann grade Ⅱ, Ⅲ and Ⅳ lumbar disc herniation were compared between the two groups.ResultsPatients in both groups underwent surgery successfully and were followed up for at least 12 months. The operation time, intraoperative blood loss and hospital stay of patients of the minimally invasive group were shorter than those of the open group, and the differences were statistically significant(P<0.05). One month after operation, the low back pain VAS score and ODI index of Pfirrmann grade Ⅳ lumbar disc herniation in the minimally invasive group were lower than those in the open group, and the difference was statistically significant(P<0.05). One year after operation, the low back pain VAS score, leg pain VAS score and ODI index of Pfirrmann grade Ⅳ lumbar disc herniation in the minimally invasive group were higher than those in the open group, and the differences were statistically significant(P<0.05). At the last follow-up, the SF-12 PCS score of Pfirrmann grade Ⅲ lumbar disc herniation in the minimally invasive group was higher than that of the open group, but the SF-12PCS score of Pfirrmann grade IV lumbar disc herniation in the minimally invasive group was lower than that of the open group,and the difference was statistically significant(P<0.05).ConclusionThere is a close relationship between the Pfirrmann classification and the postoperative efficacy of different surgical methods for the treatment of lumbar disc herniation. PTED is characteristized by less damage, shorter operation time and less intraoperative blood loss, and has a good clinical effect on Pfirrmann grade Ⅱ and Ⅲ lumbar disc herniation. PLIF has a good long-term effect on Pfirrmann grade Ⅳ lumbar disc herniation with the characteristics of complete removal of the diseased intervertebral disc and stable intervertebral fusion.