椎间孔镜下髓核摘除后纤维环缝合修复治疗腰椎间盘突出症的临床观察

Clinical observation of the treatment of lumbar disc herniation with fibrous annulus suture under en-doscope

目的:探讨在椎间孔镜下行髓核摘除+纤维环缝合修复在单节段腰椎间盘突出症患者中的临床应用及效果.方法:回顾性分析我院2018年1月~2019年12月行椎间孔镜手术治疗的60例单节段腰椎间盘突出症患者的临床资料,男45例,女15例;年龄18~56岁(平均45±5岁).其中30例行椎间孔镜下常规髓核摘除(A组);30例行髓核摘除后,镜下行纤维环缝合修复(B组).采用腰腿痛视觉模拟评分(visual analog scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和影像学检查对术后疗效进行分析评价.结果:所有患者均获随访,随访时间12~24个月,平均15个月.两组患者术后症状均明显缓解,术后各时间点腰腿痛VAS评分(术后、术后3个月、术后1年及末次随访)显著低于术前(P<0.05),组间比较无显著性差异(P>0.05);术后各时间点ODI均低于术前(P<0.05),组间比较无显著性差异(P>0.05).术后3个月复发2例(均为A组患者),1例予再次椎间孔镜手术,1例予椎间盘切除、椎间植骨融合术;其余患者影像学复查无复发,无手术节段失稳.结论:椎间孔镜下纤维环缝合符合微创理念,能即刻闭合纤维环破口,可能促进纤维环修复,降低术后复发率,近期临床效果满意.

Objectives:To investigate the application and effect of endoscopic discectomy associated with annulus suture repair in patients with single segment of lumbar disc herniation.Methods:A total of 60 patients with lumbar disc herniation treated by foraminal endoscopic surgery in our hospital from January 2018 to December 2019 were analyzed.There were 45 males and 15 females,aged from 18 to 56 years old(average 45±5).30 patients were treated with conventional nucleus pulposus excision(group A),and 30 patients were treated with fibrous annulus suture under endoscope after nucleus pulposus excision(group B).Visual analogue scale(VAS),Oswestry disability index(ODI)and imaging examination were used to evaluate the postoperative outcomes.Results:All the patients were followed up for 12 to 24 months,with an average of 15 months.Postoperative symptoms were significantly relieved in both groups.The VAS scores of low back and leg pain in both groups at different postoperative time points(right after operation,3 months,1 year and the final follow-up)were significantly lower than those before surgery(P<0.05);There was no significant difference between groups(P>0.05).The ODI at different postoperative time points were significantly lower than those before surgery(P<0.05);There was no significant difference between groups(P>0.05).2 patients(all was in group A)had recurrence 3 months after surgery,1 patient received re-foraminal endoscopic surgery,and 1 patient received discectomy and interbody fusion.Imaging review of other patients showed no recurrence or segmental instability.Conclusions:Fibroannular suture under foraminal endoscope conforms to the minimally invasive concept and has satisfactory short-term clinical effect,which can close the annulus fibrosus breach immediately,promote the repair of fibroannular,and reduce the postoperative recurrence rate.