经皮内镜椎间孔入路治疗青少年腰椎间盘突出症合并脊柱侧弯28例

Percutaneous Endoscopic Transforaminal Approach in the Treatment of Adolescent Lumbar Disc Herniation Complicated With Scoliosis:Report of 28 Cases

目的探讨经皮内镜椎间孔入路治疗青少年腰椎间盘突出症(adolescent lumbar disc herniation,ALDH)合并脊柱侧弯的疗效。方法2018年1月~2021年6月我科对28例ALDH合并脊柱侧弯采用经皮内镜椎间孔入路椎间盘髓核切除术。取俯卧位,经皮穿刺置入工作通道,于椎间孔下可视化切除突出髓核,解除神经根压迫,完成减压。结果手术时间45~75 min,(60.6±9.3)min。未见切口感染、神经损伤等手术相关并发症。28例随访14~30个月,(20.1±5.1)月。术后1个月及末次随访腰、腿部疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Dysfunction Index,ODI)、Cobb角、C_(7)铅垂线(C_(7)plumb line,C_(7)PL)与骶骨中垂线(center sacral vertical line,CSVL)之间的水平距离(CSVL-C_(7)PL)及矢状面轴向距离(sagittal vertical axis,SVA)显著低于术前(均P=0.000);末次随访腰、腿部疼痛VAS评分、ODI、Cobb角、CSVL-C_(7)PL及SVA明显低于术后1个月(P<0.05)。随访过程中2例症状复发,行椎板开椎间盘窗髓核切除术后症状缓解。末次随访改良MacNab标准疗效:优22例,良4例,可2例,优良率92.9%(26/28)。结论经皮内镜椎间孔入路椎间盘髓核切除术治疗ALDH合并脊柱侧弯,可以患者缓解临床症状,改善脊柱侧弯,临床疗效满意。

Objective To investigate the efficacy of percutaneous endoscopic transforaminal approach in the treatment of adolescent lumbar disc herniation(ALDH)complicated with scoliosis.Methods A retrospective study was conducted on clinical data of 28 cases of ALDH complicated with scoliosis from January 2018 to June 2021.Percutaneous endoscopic discectomy through the intervertebral foramen approach was performed.The patients were placed in a prone position.The percutaneous puncture was carried out to insert into the working channel,and the protruding nucleus pulposus was visually removed under the intervertebral foramen to relieve nerve root compression and complete decompression.Results The operation time was 45-75 min,with an average of(60.6±9.3)min.No surgery-related complications such as incision infection or nerve injury were found.All the 28 patients were followed up for 14-30 months,with an average of(20.1±5.1)months.The waist Visual Analogue Scale(VAS),leg VAS,Oswestry Dysfunction Index(ODI),Cobb angle,center sacral vertical line-C_(7)plumb line(CSVL-C_7PL),and sagittal vertical axis(SVA)were significantly lower at 1 month after operation and at the last follow-up than those before operation,with statistically significant differences(all P=0.000).The waist VAS,leg VAS,ODI,Cobb angle,CSVL-C_7PL,and SVA at the last follow-up were significantly lower than those at 1 month after operation,with statistically significant difference(all P<0.05).During the follow-ups,symptoms recurred in 2 patients,and fenestration of the nucleus pulposus was performed,which relieved the symptoms.The modified MacNab standard efficacy evaluation at the last follow-up showed excellent in 22 cases,good in 4 cases,and fair in 2 cases,with an excellent and good rate of 92.9%(26/28).Conclusion Percutaneous endoscopic transforaminal approach in the treatment of ALDH complicated with scoliosis can relieve clinical symptoms and improve scoliosis,the clinical effect being satisfactory.