经皮椎间孔镜技术治疗腰椎融合术后症状性邻近节段退变的早期疗效

Early efficacy of percutaneous transforaminal endoscopic discectomy in the treatment of symptomatic adjacent segment degeneration after lumbar fusion

目的探讨经皮椎间孔镜下椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎融合术后症状性邻近节段退变(adjacent segment disease,ASDis)的早期疗效。方法以本院2017年4月~2020年8月开展PTED手术治疗的26例ASDis患者作为研究对象,纳入ASDis组;同时选取同时期行PTED手术治疗的26例单纯LDH患者作为对照人群,纳入LDH组。对两组患者的围术期指标、术前、术后1个月、3个月、6个月和12个月的临床指标和总体疗效进行分组比较。结果与LDH组患者比较,ASDis组患者的X线透视次数显著增加,差异有统计学意义(P<0.05);两组的手术时间、住院时间和并发症发生率等差异均无统计学意义(P>0.05)。与术前相比,两组患者术后1~12个月的VAS评分、ODI指数均获显著改善(P<0.05),但组间差异无统计学意义(P>0.05)。术后12个月时,采用改良MacNab标准进行疗效评价,ASDis组的优良率为88.46%,LDH组的优良率为96.15%,差异无统计学意义(P>0.05)。结论采用PTED手术治疗ASDis患者,其手术获益情况与单纯LDH患者相近,有临床应用价值。

Objective To investigate the early efficacy of percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of symptomatic adjacent segment disease(ASDis)after lumbar fusion.Methods From April 2017 to August 2020,26 patients with ASDis who underwent PTED surgery in our hospital were included in the ASDis group.At the same time,26 patients with simple lumbar disc herniation(LDH)were selected as the control group.The perioperative indicators,clinical indicators and overall curative effect of the two groups before operation,1 month,3 months,6 months and 12 months after operation were compared.Results Compared with LDH group,the number of X-ray fluoroscopy in ASDis group increased significantly(P<0.05).There were no significant differences in operation time,hospital stay and incidence rate of complications between the two groups(P>0.05).Compared with before operation,the VAS score and ODI index of the two groups were significantly improved at 1-12 months after operation(P<0.05),but there were no significant differences between the two groups(P>0.05).At 12 months after operation,the improved MacNab standard was used to evaluate the curative effect.The excellent and good rate of ASDis group was 88.46%,and that of LDH group was 96.15%.There was no significant difference between the two groups(P>0.05).Conclusion The benefit of PTED in the treatment of ASDis patients is similar to that of patients with simple LDH.