椎板间入路脊柱内镜髓核摘除术联合纤维环修复技术在青年腰椎间盘突出症中应用的疗效分析

Application and clinical efficacy of percutaneous endoscopic interlaminar discectomy combined with annulus repair in young patients with lumbar disc herniation

目的探讨椎板间入路脊柱内镜髓核摘除术(PEID)联合纤维环修复技术在青年患者腰椎间盘突出症中的应用及临床疗效。方法收集2022年1月至2023年6月青岛大学附属医院骨科治疗的青年腰椎间盘突出症患者资料127例;其中67例单纯行PEID(非缝合组),60例行PEID联合纤维环缝合术(缝合组)。记录患者一般情况、手术时间及术后复发情况;收集手术录像,评估术中镜下纤维环破损情况;采用疼痛视觉模拟评分(VAS)及腰椎Oswestry功能障碍指数(ODI),分别在术前、术后1 d、1周、3个月及1年,对患者的手术疗效进行评价。术后第1天复查腰椎MR以评估突出椎间盘组织摘除的彻底性及神经减压的充分性。结果相比于非缝合组缝合组患者手术时间相对增加;纤维环边缘不均质高信号区域明显减少;椎间盘突出回缩程度更加显著;术后1 d、1周VAS评分改善明显;术后1年神经根支配区感觉障碍残留比例更低(P<0.05)。结论PEID联合纤维环缝合技术可实现纤维环一期闭合及神经周围环境重塑,缓解术后短期疼痛,减少远期神经支配区异常感觉残留,具有更加良好的临床疗效。

Objectives To explore the application and clinical efficacy of percutaneous endoscopic interlaminar discectomy(PEID)combined with annulus repair in young patients with lumbar disc herniation.Methods A total of 127 patients with lumbar disc herniation were included in this retrospective study,of which 67 patients received PEID alone(non-sutured group)and 60 patients received PEID combined with annular fibrous suture(sutured group).The general situation,operation time and postoperative recurrence of the patients were recorded.The intraoperative video was collected to evaluate the intraoperative annular fiber damage.Visual analog scale(VAS)and Oswestry disability index(ODI)were used to evaluate the surgical efficacy of patients before surgery,1 day,1 week,3 months and 1 year after surgery,respectively.Lumbar MR was reviewed on the first day after surgery to assess the thoroughness of herniated disc tissue removal and the adequacy of nerve decompression.Results The operation time of suture group was increased.The inhomogeneity and high signal area of the annulus edge decreased obviously.The degree of retraction of herniated intervertebral disc was more significant.VAS scores improved significantly 1 day and 1 week after surgery.The proportion of residual sensory disturbance in nerve root innervation area was lower 1 year after surgery(P<0.05).Conclusions PEID combined with annular fibrous suture technology can achieve primary closure of the fibrous ring and remodeling of the peripheral nerve environment,relieve short-term postoperative pain,reduce long-term abnormal sensory residual in the innervation area,and have better clinical efficacy.