内镜椎间盘切除术是否修复纤维环比较

Comparison of endoscopic discectomies with or without repair of annulus fibrosus defect

[目的]探讨采用全可视内镜下髓核摘除联合纤维环修复治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。[方法]2019年1月—2021年1月共82例LDH患者纳入本研究,依据术前医患沟通结果,35例采用全内镜下髓核摘除联合纤维环修复,另外47例采用单纯全内镜下髓核摘除,未修复纤维环。比较两组围手术期、随访和影像资料。[结果]所有手术顺利完成,两组患者均无硬膜囊撕裂、神经根损伤、感染等严重并发症。修复组的手术时间显著长于未修复组[(66.8±11.2)min vs(58.4±12.9)min,P=0.034],但是两组切口长度、手术出血量、术后下地时间、切口愈合等级和术后住院天数的差异均无统计学意义(P>0.05)。两组患者均获随访18个月以上。随访过程中,椎间盘突出复发,修复组为1例(2.8%),未修复组为2例(4.2%),两组复发率差异无统计学意义(P>0.05)。随时间推移,两组患者腰痛VAS和腿痛VAS评分,以及ODI评分均显著下降(P<0.05)。相应时间点,两组间腰痛VAS和腿痛VAS评分,以及ODI评分的差异均无统计学意义(P>0.05)。影像方面,与术前相比,术后10 d和末次随访时,两组患者责任椎管面积和腰椎前凸角均显著增加(P<0.05);修复组责任椎间隙高度无显著变化(P>0.05),但未修复组末次随访时责任椎间隙高度显著减小(P<0.05)。相应时间点,两组患者间责任椎管面积、腰椎前凸角的差异无统计学意义(P<0.05);但是末次随访时,修复组的椎间隙高度显著大于未修复组[(9.0±0.2)mm vs (7.4±0.5)mm,P=0.023]。[结论]内镜下髓核切除联合纤维环修复术治疗腰椎间盘突出症是可行的技术。虽然修复组与未修复组早期临床效果相似,但缝合修复纤维环缺损有利于保持椎间隙高度。

[Objective]To evaluate the clinical outcomes of endoscopic removal of nucleus pulposus and suture repair of annulus fibrosus defect in the treatment of lumbar disc herniation(LDH).[Methods]From January 2019 to January 2021,a total of 82 patients who received endoscopic discectomy for LDH were included in this study.According to preoperative doctor-patient communication,35 patients underwent endoscopic removal of nucleus pulposus and suture repair of annulus fibrosus defect,while other 47 patients underwent endoscopic removal of nucleus pulposus without repairing annulus fibrosus.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients in both groups were operated on successfully with no serious complications,such as dural sac tear,nerve root injury and infection.The repaired group consumed significantly longer operation time than the non-repaired group[(66.8±11.2)min vs(58.4±12.9)min,P=0.034],but there were no statistically significant differences between the two groups in incision length,intraoperative blood loss,postoperative time of ambulation,incision healing grade and postoperative hospital stay(P>0.05).During follow-up lasted for more than 18 months,herniation recurrence was noted in 1 case(2.8%)in the repaired group,while 2 cases(4.2%)in the non-repaired group,which was not statistically significant between the two groups(P>0.05).The VAS scores for both lower back pain and leg pain,as well as ODI scores were significantly decreased in both groups over time(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).Radiographically,the cross area of the responsible spinal canal and the lumbar lordotic angle significantly increased in both groups at 10 days after surgery and the last follow-up compared with those preoperatively(P<0.05).The intervertebral space height of the responsible segment remained unchanged in the repaired group(P>0.05),whereas significantly declined in the non-repaired group at the latest follow-up compared with that before operation(P<0.05).At any corresponding time points,there were no significant differences in responsible spinal canal area and lumbar lordotic angle between the two groups(P>0.05).However,the repaired group had significantly higher intervertebral space height of the affected segment than the non-repaired group at the latest follow-up[(9.0±0.2)mm vs(7.4±0.5)mm,P=0.023].[Conclusion]Endoscopic nucleus pulposus removal combined with annulus fiber repair is feasible for the treatment of lumbar disc herniation.Although the repaired group achieves similar early clinical consequences with the unrepaired group,the suture repair of annulus fibrosus defect secondary to discectomy is benefit to maintain the intervertebral space height.