椎间盘退变程度与脊柱内镜手术治疗腰椎间盘突出症临床疗效的相关性研究

Correlation between the Degree of Intervertebral Disc Degeneration and the Clinical Efficacy of Endoscopic Spinal Surgery for Lumbar Disc Herniation

目的:观察并分析椎间盘退变程度与脊柱内镜手术治疗腰椎间盘突出症临床疗效的相关性。方法:回顾性分析2018年1月至2021年12月行经皮椎间孔镜下腰椎间盘髓核切除术(PELD)的106例腰椎间盘突出症(LDH)患者临床资料。106例均为单间隙患者,按照Pfirrmann腰椎间盘退变分级标准:Ⅰ级6例,Ⅱ级8例,Ⅲ级28例,Ⅳ级34例,Ⅴ级30例。记录所有患者术前及术后各时间点腰部疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分,比较术前和术后不同分组VAS及ODI评分,并计算出VAS评分和ODI评分改善率;分析椎间盘退变Pfirrmann分级与改善率的相关性,并记录所有患者术后并发症发生情况。结果:患者术前VAS评分和ODI评分比较差异无统计学意义(P>0.05);术后1 d、3个月、12个月VAS评分和ODI评分与术前比较差异有统计学意义(P<0.05);Ⅰ、Ⅱ、Ⅲ级术后各时间节点的VAS评分和ODI评分比较差异无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ级与Ⅳ、Ⅴ级术后各时间节点VAS评分和ODI评分比较差异有统计学意义(P<0.05);Pfirrmann分级与VAS评分和ODI评分改善率行相关性检验,差异有统计学意义(P<0.05);106例患者术后并发症发生率为1.8%。结论:经皮椎间孔镜下腰椎髓核切除术治疗腰椎间盘不同退变程度的腰椎间盘突出症患者,疗效确切,但Pfirrmann分级与腰椎间盘髓核切除术治疗腰椎间盘突出症的疗效整体相关。该分级对微创术前患者、术式的合理选择及术后疗效预测有一定参考价值。

Objective:To observe and analyze the correlation between the degree of intervertebral disc degeneration and the clinical efficacy of endoscopic surgery for lumbar disc herniation.Methods:106 patients with lumbar disc herniation(LDH)who underwent percutaneous lumbar foraminal discectomy(PELD)from January 2018 to December 2021 were analyzed retrospectively.106 cases were all single space patients.According to Pfirrmann's classification standard of lumbar intervertebral disc degeneration,6 cases were gradeⅠ,8 cases were gradeⅡ,28 cases were gradeⅢ,34 cases were gradeⅣ,and 30 cases were gradeⅤ.The visual analogne scale(VAS)and Oswestry dysfunction index(ODI)of lumbar pain scores were recorded at various time points before and after operation in all patients.The VAS and ODI of different groups before and after operation were compared,and the improvement rates of VAS and ODI were calculated.The correlation between Pfirrmann classification and improvement rate of intervertebral disc degeneration was analyzed.The postoperative complications of all patients were recorded.Results:There was no difference in VAS and ODI scores among the groups before operation(P>0.05).The VAS score and ODI score at 1 d,3 months and 12 months after operation in each group were different from those before operation(P<0.05).There was no difference in VAS and ODI between gradeⅠ,ⅡandⅢ(P>0.05).The VAS and ODI of each node in gradeⅠ,ⅡandⅢwere different from those in gradeⅣandⅤ(P<0.05).The Pfirrmann classification group was tested for correlation with the improvement rate of VAS and ODI,and the difference was statistically significant(P<0.05).The incidence of postoperative complications in 106 patients was 1.8%.Conclusion:Percutaneous lumbar discectomy under endoscope has a definite efficacy on patients with LDH with different degrees of degeneration of lumbar intervertebral disc,but Pfirrmann grade is negatively correlated with the overall efficacy of PELD on LDH.This classification has a certain reference value for the reasonable selection of patients and surgical methods before minimally invasive surgery and the prediction of postoperative efficacy.