经皮脊柱内镜腰椎间盘摘除术在治疗严重症状微小腰椎间盘突出中的临床疗效分析

Analysis of the Clinical Effect of Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Severe Symptomatic Small Lumbar Disc Herniation

目的:分析脊柱内镜腰椎间盘摘除术在治疗严重症状微小腰椎间盘突出中的临床疗效。方法:选取2020年1月-2021年5月通许县中医院收治的110例严重症状的微小腰椎间盘突出患者作为研究对象。分析各患者病历资料后根据制定手术方案的不同将患者分为对照组与观察组,每组各55例。对照组采用小切口椎间板开窗髓核摘除术,观察组采用经皮脊柱内镜腰椎间盘摘除术。比较两组患者的治疗效果,如围术期指标、并发症、腰椎功能状况、腰背肌生物力学性能等。结果:两组患者均表现为一侧下肢放射性剧烈疼痛,20例位于L4.5,90例位于L5S1,各患者术中均得到确认神经根受压;观察组围术期指标低于对照组,差异有统计学意义(t=22.9642、74.1890、62.9300、74.2262,P<0.05);术后3个月时,观察组JOA高于对照组,ODI评分低于对照组,差异有统计学意义(t=0.0674、32.5258,P<0.05),术前脊柱对称性指标差异无统计学意义(P>0.05),术后3个月时,观察组侧屈角比(LR)、侧弯角(M)、旋转角(HA)低于对照组,差异有统计学意义(P<0.05),观察组并发症为1.82%,低于对照组的21.82%,差异有统计学意义(χ^(2)=10.5551,P<0.05)。结论:严重症状的微小腰椎间盘突出患者主要表现为下肢放射性剧烈疼痛,病程短,发病急,局部炎症重,CT薄层扫描检查判定价值高。在治疗方面,相比于小切口椎间板开窗髓核摘除术,经皮脊柱内镜腰椎间盘摘除术可快速缓解症状,且并发症少,术后功能恢复更为良好。

Objective:To analyze the clinical efficacy of spinal endoscopic lumbar discectomy in the treatment of severe symptomatic micro-lumbar disc herniation.Methods:A total of 110 patients with severe lumbar disc herniation who were admitted to the hospital from January 2020 to May 2021 were selected as the research subjects.After analyzing the medical records of each patient,the patients were divided into the control group and the observation group according to different surgical plans,with 55 cases in each group.The control group was treated with small incision intervertebral plate fenestration nucleus pulposus,and the observation group was treated with percutaneous endoscopic lumbar discectomy.The therapeutic effects of the two groups of patients,such as perioperative indicators,complications,lumbar spine function,and biomechanical properties of the lumbar back muscles,were compared.Results:Both groups presented with severe radiating pain in one lower extremity,20 cases were located in L4.5,90 cases were located in L5S1,and nerve root compression was confirmed in all patients.The perioperative indexes in the observation group were lower than those in the control group,and the difference was statistically significant(t=22.9642,74.1890,62.9300,74.2262,P<0.05).The JOA of the observation group was higher than that of the control group,and the ODI score was lower than that of the control group,and the difference was statistically significant(t=0.0674,32.5258,P<0.05).There was no statistically significant difference in preoperative spine symmetry index(P>0.05).At 3 months after operation,the LR,M and HA of the observation group were lower than those of the control group,and the difference was statistically significant(P<0.05).The incidence of complications in the observation group was 1.82%,which was lower than 21.82%in the control group,and the difference was statistically significant(χ^(2)=10.5551,P<0.05).Conclusion:Severely symptomatic patients with micro-lumbar disc herniation are mainly manifested as severe radiating pain in the lower extremities,short course of disease,acute onset,severe local inflammation,and high diagnostic value of CT thin-section scan.In terms of treatment,percutaneous endoscopic lumbar discectomy can relieve symptoms quickly,with fewer complications and better postoperative functional recovery compared with small incision fenestrated nucleotomy.