髂嵴高度对经皮脊柱内镜椎间孔入路腰椎间盘切除术治疗L_(5)~S_(1)腰椎间盘突出症的临床影响

Clinical Impact of Iliac Crest Height on Percutaneous Endoscopic Transforaminal Discectomy for L_(5)-S_(1) Lumbar Disc Herniation

目的探讨髂嵴高度对经皮脊柱内镜椎间孔入路腰椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗第5腰椎至第1骶椎(L_(5)~S_(1))节段腰椎间盘突出症的临床疗效影响。方法回顾性分析2020-01/2020-12月在作者医院使用经椎间孔内窥镜脊柱手术系统(transforaminal endoscopic spine system,TESSYS)技术治疗的92例L_(5)~S_(1)单节段椎间盘突出症患者的临床资料。根据髂嵴最高点与L_(4)、L_(5)椎弓根的位置关系分为3组:A组(髂嵴高度低于L_(5)椎弓根上缘水平线,n=51)、B组(髂嵴高度位于L_(4)椎弓根下缘水平线与L_(5)椎弓根上缘水平线之间,n=35)、C组(髂嵴最高点位于L4椎弓根下缘水平线以上,n=6)。比较患者的术前,术后1周,术后1、3、12个月的Oswestry功能障碍指数(Oswestry disability index,ODI)、腰部疼痛视觉模拟量表(visual analogue scale,VAS)评分差异。结果92例患者均成功完成手术,平均手术时间为(86.52±13.54)min,术中平均出血量为(23.01±1.45)ml。3组患者的手术时间、术中出血量,差异均无统计学意义(P>0.05)。与术前比较,术后1周,1、3、12个月3组患者的VAS评分和ODI均显著降低(P均<0.05)。A、B组术后1周,术后1、3、12个月的VAS和ODI评分均低于C组(P均<0.05);A、B组术后1周、术后1个月的VAS评分差异有统计学意义(P均<0.05)。C组患者术中发生并发症1例,A、B组无患者发生术中并发症。全部患者随访时间为12~17(12.40±2.40)个月。随访期间无患者发生硬膜外血肿、手术切口感染、腰椎不稳和术后难治性腰背痛等并发症。结论髂嵴高于L4椎弓根下缘是影响TESSYS技术治疗L_(5)~S_(1)腰椎间盘突出症患者效果的因素之一。

Objective To investigate the clinical impact of iliac crest height on percutaneous endoscopic transforaminal discectomy(PETD)for lumbar disc herniation at the level of the 5th lumbar to 1st sacral(L_(5)-S_(1))segments.Methods The clinical data of 92 patients with L_(5)-S_(1) single segment disc herniation treated by transforaminal endoscopic spine system(TESSYS)technique in author′s hospital from January 2020 to December 2020 were retrospectively reviewed.The positional relationship between the highest point of the iliac crest and the L_(4) and L_(5) pedicles was divided into 3 groups:group A,below the horizontal line of the superior border of the L_(5) pedicles(n=51);group B,the height of the iliac crest was located between the horizontal line at the lower border of the L4 pedicle and the horizontal line at the upper border of the L_(5) pedicle(n=35);group C,the highest point of the iliac crest was located above the horizontal line at the lower border of the L_(4) pedicle(n=6).The patients′Oswestry disability index(ODI),visual analogue scale(VAS)scores of lumbar pain were preoperatively compared at the 1st week,and the 1st,3rd and 12th months after surgery.Results All 92 patients successfully completed the surgery,with an average surgical time of(86.52±13.54)min and an average intraoperative bleeding volume of(23.01±1.45)ml.There was no statistically significant difference in the surgical time and intraoperative bleeding volume among the 3 groups of patients(P>0.05).Compared with before,VAS scores and ODI in 3 groups were significantly decreased at the 1st week,and the 1st,3rd and 12th months after surgery(all P<0.05).VAS and ODI scores of group A and group B were lower than those in group C at the 1st week,and the 1st,3rd and 12th months after surgery(all P<0.05);there were significant differences in VAS scores between group A and group B at 1 week and 1 month after surgery(all P<0.05).One patient in group C experienced intraoperative complications,while no patients in group A and group B experienced intraoperative complications.The follow-up time for all patients was 12-17(12.40±2.40)months.During the follow-up period,no patients experienced complications such as epidural hematoma,surgical incision infection,lumbar instability and postoperative refractory low back pain.Conclusion The iliac crest higher than the lower edge of the L_(4) pedicle is one of the factors affecting the effects of the TESSYS technique in patients with L_(5)-S_(1) lumbar disc herniation.