不同入路微创经皮椎间孔镜下髓核摘除术在复发性腰椎间盘突出的应用比较

Comparison of minimally invasive percutaneous intervertebral foraminoscopic extraction of nucleus pulposus with different approaches in patients with recurrent lumbar disc herniation

目的 探究不同入路微创经皮椎间孔镜下髓核摘除术在复发性腰椎间盘突出的应用比较。方法 选取某院2020年2月~2021年12月收治的复发性腰椎间盘突出症患者100例作为研究对象,按脊柱不同入路将其分为A组(n=25)经典椎间孔入路,B组(n=25)经椎间孔侧后方入路,C组(n=25)经后路椎板间入路,D组(n=25)采用改良椎间孔入路。比较各组术前、术后1周、术后1个月、术后3个月双下肢疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),术前术后腰椎曲度指数(LCI)、椎间隙高度和术前术后白细胞介素-8(IL-8)、白细胞介素-17(IL-17)的变化情况。结果 与术前相比,术后四组患者各时间段的VAS评分均显著下降。四组同一时间点VAS评分差异均无统计学意义(P> 0.05);与术前相比,术后四组患者各时间段的ODI评分均显著降低;四组同一时间点ODI评分差异均无统计学意义(P> 0.05);与术前相比,术后3个月四组患者的LCI和椎间隙高度均降低,但四组间LCI和椎间隙高度的差异均无统计学意义(P> 0.05);与术前相比,术后3个月四组患者的炎性因子水平均显著下降,四组同一时间点IL-8、IL-17的差异均无统计学意义(P> 0.05)。结论 椎间孔镜髓核摘除术治疗复发性椎间盘突出效果良好,可有效改善疼痛及功能障碍状况,其中改良椎间孔入路手术操作范围更大,术中探查及摘除责任髓核更彻底;但需要根据患者腰椎间盘突出特点选择合适的手术入路。

Objective To compare the application of minimally invasive percutaneous intervertebral foraminoscopic extraction of nucleus pulposus with different approaches in recurrent lumbar disc herniation.Methods 100 patients with recurrent lumbar disc herniation admitted to our hospital from February 2020 to December 2021 were selected as study subjects and divided into group A(n=25)with classical foraminal approach,group B(n=25)with posterior foraminal approach,group C(n=25)with posterior interlaminar approach,group D(n=25)with modified foraminal approach according to different spinal approaches.Visual analogue score(VAS)and Oswestry disability index(ODI)were compared before surgery,1 week after surgery,1 month after surgery and 3 months after surgery,lumbar curvature index(LCI),vertebral space height and the changes of interleukin-8(IL-8)and interleukin-17(IL-17)were compared before and after operation.Results Compared with the preoperative results,the VAS scores of the four groups decreased significantly at all time periods.There was no significant difference in VAS scores among the four groups at the same time point(P>0.05).Compared with the preoperative results,the ODI scores of the four groups were significantly decreased at all time periods.There was no significant difference in ODI scores among the four groups at the same time point(P>0.05).Compared with preoperative,LCI and intervertebral space height of the four groups were decreased 3 months after surgery,but there was no statistical significance in LCI and intervertebral space height between the four groups(P>0.05).Compared with preoperative,the levels of inflammatory factors in the four groups were significantly decreased 3 months after surgery,and there was no statistical significance in IL-8 and IL-17 between the four groups at the same time point(P>0.05).Conclusion Foraminal endoscopic extraction of nucleus pulposus is effective in the treatment of recurrent disc herniation,and can effectively improve the pain and dysfunction.The modified foraminal approach has a larger operation scope,and the intraoperative exploration and removal of the responsible nucleus pulposus are more thorough.However,it is necessary to select the appropriate surgical approach according to the characteristics of patients with lumbar disc herniation.