椎间隙入路关节突外侧开窗对腰椎间盘突出症预后影响

Effect of Lateral Facet of Articular Process Fenestration Via Intervertebral Space Approach on the Prognosis of Lumbar Disc Herniation

目的:研究分析椎间隙入路关节突外侧开窗对腰椎间盘突出症预后的影响。方法:选取武汉中西医结合骨科医院、长江大学附属荆州医院2020年9月—2022年10月收治的72例腰椎间盘突出症患者,通过随机数字表法将其分为对照组(常规穿刺入路脊柱内镜手术疗法,36例)与观察组(椎间隙入路关节突外侧开窗手术疗法,36例)。研究分析其临床指标、日本骨科协会(Japanese orthopaedic association,JOA)下腰痛评分表评分、视觉模拟评分法(VAS)评分、治疗优良率、腰椎后伸、前屈、左侧屈和右侧屈运动范围的改变。结果:观察组治疗优良率明显高于对照组,差异有统计学意义(P<0.05)。观察组手术时间、住院时间均短于对照组,差异均有统计学意义(P<0.05),两组术中出血量比较差异无统计学意义(P>0.05)。治疗后90 d,观察组VAS评分低于对照组,JOA下腰痛评分表评分高于对照组,差异均有统计学意义(P<0.05)。治疗后90 d,观察组腰椎后伸、前屈、左侧屈及右侧屈运动范围均高于对照组,差异均有统计学意义(P<0.05)。两组术后切口血肿、术后切口感染、神经根或者硬膜撕裂等并发症发生率比较,差异均无统计学意义(P>0.05)。结论:对腰椎间盘突出症实施椎间隙入路关节突外侧开窗治疗方式,临床治疗效果显著,能够明显改善腰椎功能及预后,调整腰椎后伸、前屈、左侧屈及右侧屈运动范围,降低疼痛感。

Objective:To analyze the effect of lateral facet of articular process fenestration via intervertebral space approach on the prognosis of lumbar disc herniation.Method:A total of 72 patients with lumbar disc herniation admitted to Wuhan Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine and Jingzhou Hospital Affiliated to Changjiang University from September 2020 to October 2022 were selected and divided into the control group(conventional puncture approach endoscopic spine surgery therapy,36 cases)and the observation group(lateral facet of articular process fenestration via intervertebral space approach surgery therapy,36 cases)by the random number table method.The clinical indexes,Japanese orthopaedic association(JOA)low back pain scale score,visual analogue scale(VAS)score,excellent and good rate of treatment,changes of ranges motion of lumbar spine extension,flexion,left and right flexion were analyzed.Result:The excellent and good rate of treatment of observation group was obviously higher than that of control group,the difference was statistically significant(P<0.05).The operation time and hospitalization time of the observation group were shorter than those of the control group,the differences were statistically significant(P<0.05),there was no significant difference in intraoperative blood loss between the two groups(P>0.05).At 90 days after treatment,the VAS score in the observation group was lower than that in the control group,the JOA low back pain scale score in the observation group was higher than that in the control group,the differences were statistically significant(P<0.05).At 90 days after treatment,the ranges motion of lumbar spine extension,flexion,left and right flexion in the observation group were higher than those in the control group,the differences were significant(P<0.05).There were no significant differences in the incidences of postoperative incision hematoma,postoperative incision infection,nerve root or dural tear between the two groups(P>0.05).Conclusion:Lateral facet of articular process fenestration via intervertebral space approach for the treatment of lumbar disc herniation has significant clinical effect,which can significantly improve the function and prognosis of the lumbar spine,adjust the ranges of motion of lumbar extension,flexion,left flexion and right flexion,and reduce pain.