经皮椎间孔镜腰椎间盘切除术治疗继发性脊柱侧凸与非侧凸腰椎间盘突出症患者的效果比较

Comparison of percutaneous endoscopic lumbar discectomy in the treatment of secondary scoliosis and non-scoliosis lumbar disc herniation

目的研究经皮椎间孔镜腰椎间盘切除术治疗继发性脊柱侧凸与非侧凸腰椎间盘突出症患者的临床效果。方法选取2018年3月至2020年1月河北中医学院第一附属医院骨伤一科采用经皮椎间孔镜腰椎间盘切除术治疗的45例腰椎间盘突出症患者作为研究对象。根据脊柱是否侧凸将其分为侧凸组(21例)与非侧凸组(24例)。观察并比较两组手术时间、术中出血量及住院天数,记录两组术中不良反应发生情况。记录并比较两组术前及术后2周、6个月的视觉模拟评分法(VAS)评分、Oswestry功能障碍指数(ODI),分析侧凸组腰椎Cobb角变化情况。结果两组手术时间、术中出血量及住院天数比较,差异均无统计学意义(P>0.05)。两组术中均无神经血管损伤、硬脊膜撕裂及椎间隙感染等严重并发症的发生。两组术后2周、6个月的腰部及腿部VAS评分、ODI均低于术前,术后6个月的腰部及腿部VAS评分、ODI均低于术后2周,差异有统计学意义(P<0.05)。两组各时间点的腰部及腿部VAS评分、ODI比较,差异均无统计学意义(P>0.05)。侧凸组术后2周、6个月的Cobb角均低于术前,术后6个月的Cobb角低于术后2周,差异有统计学意义(P<0.05)。结论经皮椎间孔镜腰椎间盘切除术治疗继发性脊柱侧凸与非侧凸腰椎间盘突出症对患者创伤小,术后恢复快,从短期观察来看,可以获得相似的临床效果,值得进一步研究。

Objective To study the clinical effect of percutaneous endoscopic lumbar discectomy for secondary scoliosis and non-scoliosis lumbar disc herniation.Methods From March 2018 to January 2020,45 patients with lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy in the First Affiliated Hospital of Hebei University of Chinese Medicine were selected as the research subjects.According to scoliosis,the patients were divided into the scoliosis group(21 cases)and the non-scoliosis group(24 cases).The operation time,intraoperative blood loss,and hospitalization days of the two groups were observed and compared,the incidence of adverse reactions in the two groups was recorded.Visual analogue scale(VAS)score and Oswestry disability index(ODI)were recorded and compared between the two groups before operation and two weeks and six months after operation,and changes of lumbar Cobb angle in scoliosis group were analyzed.Results There were no significant differences in operative time,intraoperative blood loss,and hospitalization days between the two groups(P>0.05).No serious complications such as neurovascular injury,dural tear,and intervertebral space infection occurred in both groups.VAS score and ODI of waist and leg in both groups at two weeks and six months after operation were lower than those before operation,and VAS score and ODI of waist and leg at six months after operation were lower than those at two weeks after operation,the differences were statistically significant(P<0.05).There were no significant differences in VAS score and ODI of waist and leg at each time point between the two groups(P>0.05).Cobb angle in the scoliosis group was lower than that before operation at two weeks and six months after operation,Cobb angle at six months after operation was lower than that at two weeks after operation,the differences were statistically significant(P<0.05).Conclusion Percutaneous endoscopic lumbar discectomy for the treatment of secondary scoliosis and non-scoliosis lumbar disc herniation has little trauma and fast postoperative recovery.From the short-term observation,similar clinical effects can be obtained,which is worthy of further study.