“U”路经皮椎间孔镜治疗腰椎管狭窄伴腰椎间盘突出症疗效随访研究

The postoperative therapeutic effect of "U" route transforaminal percutaneous endoscopic lumbar discectomy on lumbar spinal stenosis combined with disc herniation

目的 探讨“U”路经皮椎间孔镜(Transforaminal endoscopic lumbar discectomy,PELD)手术治疗腰椎管狭窄(Lumbar central spinal stenosis,LSS)伴腰椎间盘突出(Lumbar disc herniation,LDH)的安全性和术后1年临床疗效。方法 回顾分析2018年8月至2020年1月诊断为LSS伴LDH,并接受“U”路PELD手术治疗并完成术后1年随访患者33例。记录患者基本临床资料,采用数字量表(Numerical rating scale,NRS)评估患者术后1 d、1月、3月、6月和1年腰背部和下肢疼痛,Oswestry功能障碍指数(Oswestry disability index,ODI)评估生活质量,采用改良Macnab评估术后3月和1年临床预后。结果 纳入患者中男性19例(57.6%)、女性14例(42.4%),年龄(59.8±9.28)岁;患者症状持续时间27(12~1040)周,手术时间(95.9±24.29)min,住院天数为4(3~10)d。有3例患者失访,术后各时间点腰背部和下肢痛NRS评分(P<0.001)以及ODI(P<0.001)均较术前显著降低,术后3月和1年的改良Macnab评估“优良率”均为96.7%(P>0.05)。所有患者无并发症发生,无患者因症状复发需要接受二次微创或开放手术治疗。结论 “U”路PELD为治疗LSS伴LDH安全有效的手术方式,但由于本研究的局限性,结论需大样本随机对照研究进一步证实。

Objective To explore the safety and effectiveness of the "U" route procedure of transforaminal endoscopic lumbar discectomy(PELD) on the treatment of lumbar spinal stenosis(LSS) combined with lumbar disc herniation(LDH). Methods Thirty-three patients who diagnosed with LSS combined LDH, and agreed to receive the "U" route PELD surgery during January 2018 and January 2020 were recruited. The infor-mation of age, gender, duration of symptoms, surgical level, operation minutes and hospital stay were recorded for all patients. Moreover, the low back and leg numerical rating scale(NRS) pain ratings, and oswestry disability index(ODI) were assessed at pre-operation, postoperative 1-day, 1-month,3-month, 6-month and 1-year. The prognosis of the patients was evaluated with modified Macnab at the postoperative 3-month, 6-month and 1-year visits. Results The recruited 33 patients includes 19 males(57.6%) and 14 females(42.4%), and the average age was 59.8 ±9.28 years. The median symptoms duration was 27(12-1040) weeks, the average operation time was 95.9±24.29 mins, and the hospital stay was 4(3-10) days. The surgical level distributes from L3/4to L5/S1, and there were 4 patients were on L3/4, 10 patients were on L4/5, 11 patients on L5/S1and 2 patients were on L4/5 and L5/S1. One patient was lost to the follow-up at postoperative 1-month, and 2 patients at postoperative 6-minth, and the other 30 patients completed the 1-year follow-up, and no complication of infection, nerve root injury, epidural tear or cerebrospinal fluid leak was reported. The postoperative low back and leg NRS pain rating scores, and ODI scores were significantly decreased compared with pre-operation( P<0.01). The satisfactory rate reached96.7% at postoperative 3-month, 6-month and 1-year visits(P>0.05). No patient needed to receive a second open or minimally invasive surgery during the follow-up. Conclusion Our results suggested the "U" route procedure of PELD was a safe and effective therapy for LSS combined LDH patients, but due to the limitations of this study, further randomized clinical research were needed to make a confirmative conclusion.