经皮椎间孔镜椎间盘切除术联合富血小板血浆修复治疗青壮年腰椎间盘突出症的临床疗效分析

Clinical effect analysis of percutaneous transforaminal endoscopic discectomy combined with plateletrich plasma repair for young adults with lumbar disc herniation

目的:探讨经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)联合富血小板血浆(platelet-rich plasma,PRP)修复治疗青壮年腰椎间盘突出症(lumbar disc herniation,LDH)的临床安全性及有效性。方法:回顾性分析2017年1月~2019年12月符合纳入与排除标准的120例LDH患者的临床资料。其中,单纯内镜治疗组(A组,n=40),内镜联合一次离心PRP治疗组(B组,n=42)、内镜联合二次离心PRP治疗组(C组,n=38)。记录患者术前、术后7d及术后3、6、12个月时的疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科学会(Japanese Orthopedic Association,JOA)评分、Oswestry功能障碍指数(Oswestry disability index,ODI);测量术前、术后6、12个月及末次随访时椎管横截面积(spinal canal crosssectional area,SCSA)、髓核与脑脊液信号强度比值(signal intensity ratio,SIR)、椎间盘高度指数(disc height index,DHI)及椎间盘Pfirrmann分级。术后12个月时采用JOA评分改善率评价临床疗效。结果:患者均完成随访,随访时间24~33(28.02±2.19)个月。随访期间均未发生椎间隙感染、神经根损伤、节段不稳等严重并发症。三组患者术后各时间点VAS、JOA评分及ODI较术前均有明显改善,差异有统计学意义(P<0.05)。三组VAS、JOA评分及ODI术后7d、3个月时组间两两比较均有统计学差异(P<0.05);术后6个月时A组与C组、B组与C组比较有统计学差异(P<0.05),而A组与B组比较无统计学差异(P>0.05)。末次随访时,SCSA、SIR及椎间盘Pfirrmann分级三组间比较有统计学差异(P<0.05);A组与B组、A组与C组比较均有统计学差异(P<0.05),B组与C组比较无统计学差异(P>0.05)。DHI在术前、术后6、12个月及末次随访时比较均无统计学差异(P>0.05)。按照JOA评分改善率评价标准,术后12个月时JOA评分优良率A组为92.5%,B组为95.2%,C组为97.4%,差异无统计学意义(P>0.05)。结论:PTED联合PRP修复治疗青壮年LDH安全有效,在一定程度上可延缓腰椎间盘的退变。

Objectives:To investigate the clinical safety and efficacy of percutaneous transforaminal endoscopic discectomy(PTED)combined with platelet-rich plasma(PRP)repair in the treatment of lumbar disc herniation(LDH)in young adults.Methods:The clinical data of 120 LDH patients who met the inclusion and exclusion criteria from January 2017 to December 2019 were retrospectively analyzed.Among them,group A(n=40)underwent endoscopic treatment only,group B(n=42)underwent endoscopic treatment combined with one-step centrifugation PRP and group C(n=38)underwent endoscopic treatment combined with two-step centrifugation PRP.The visual analogue scale(VAS),Japanese Orthopedic Association(JOA)score for lumbar spine and Oswestry disability index(ODI)were recorded preoperatively,and at 7d,3,6 and 12 months postoperatively.Spinal canal cross-sectional area(SCSA),signal intensity ratio(SIR)between nucleus pulposus and cerebrospinal fluid,disc height index(DHI)and disc Pfirrmann grading were measured preoperatively,and at 6 and 12 months postoperatively and the final follow-up.The improvement rate of JOA score was used to evaluate the clinical efficacy at 12 months postoperatively.Results:The patients were followed up for 24-33(28.02±2.19)months and no serious complications such as intervertebral space infection,nerve root tear or fracture,and segmental instability occurred during the study.The postoperative VAS score,JOA score and ODI of the three groups were all significantly improved compared with those before operation(P<0.05).A pairwise comparison of VAS,JOA and ODI between the three groups showed statistic differences at 7d and 3 months postoperatively(P<0.05);and there were significant differences between groups A and C as well as between groups B and C(P<0.05)at 6 months postoperatively,but there was no statistical difference between group A and group B(P>0.05).At final follow-up,there were significant differences in SCSA,SIR and disc Pfirmann grading between group A and B as well as between group A and C(P<0.05),but there was no significant difference between group B and group C(P>0.05).In addition,DHI did not show a significant difference between the three groups before operation,at postoperative 6 and 12 months and final follow-up(P>0.05).According to the JOA score improvement rate,the excellent and good rate of JOA in group A,group B and group C was 92.5%,95.2%and 97.4%,and with no statistically significant difference(P>0.05),respectively at postoperative 12 months.Conclusions:PTED combined with PRP repair in the treatment of LDH in young adults is safe and effective,and can delay the degeneration of intervertebral discs to a certain extent.