经皮椎间孔脊柱内镜技术与椎板开窗髓核摘除术对腰椎间盘突出症的治疗效果分析

Curative effect of percutaneous transforaminal spinal endoscopy and fenestration discectomy on lumbar disc herniation

目的:研究经皮椎间孔脊柱内镜技术与椎板开窗髓核摘除术治疗腰椎间盘突出症对患者腰背肌生物力学、功能障碍指数的影响。方法:回顾性分析2020年1月至2022年12月期间本院收治的68例腰椎间盘突出症患者作为研究对象。根据患者治疗方法不同,将患者分为孔镜组(30例,采用经皮椎间孔脊柱内镜技术治疗)和开窗组(38例,采用椎板开窗髓核摘除术治疗)。分析对比两组的围术期相关指标、对比术前1d和术后6m内的腰背肌生物力学性能前降力矩(Peak torque,PT)、背部屈/伸比(Flexion extension ratio,F/E)、平均功率(Average power,AP)、腰椎功能障碍程度(Oswestry disability index,ODI)、疼痛程度(视觉模拟评分(Visual analoguescore,VAS))、术后1 m内的并发症发生情况等。结果:孔镜组围术期指标均优于开窗组(P<0.05)。与手术前1d相比,各手术组的AP、PT均明显升高,F/E降低,ODI、VAS评分降低(P<0.05),其中孔镜组更为显著(P<0.05)。结论:经皮椎间孔脊柱内镜技术治疗腰椎间盘突出症患者的围术期指标、腰背肌生物力学评分、功能障碍指数评分、术后疼痛评分、并发症发生率都优于椎板开窗髓核摘除术。

Objective:To study the effects of percutaneous transforaminal spinal endoscopy and fenestration discectomy on biomechanics of lumbar dorsal muscles and dysfunction index in patients with lumbar disc herniation.Methods:A retrospective analysis was performed on the 68 patients with lumbar disc protrusion admitted to the hospital between January 2020 and December 2022.According to different treatment methods,they were divided into endoscope group(30 cases,percutaneous transforaminal spinal endoscopy)and fenestration group(38 cases,fenestration discectomy).The perioperative indexes,biomechanics properties of lumbar dorsal muscles(peak torque(PT),flexion/extension ratio(F/E),average power(AP)),scores of lumbar dysfunction(Oswestry disability index(ODI))and pain(visual analogue scale(VAS))at 1day before surgery and in 6 months after surgery,and occurrence of complications within 1 month after surgery in the two groups were compared.Results:The perioperative indexes in endoscope group were better than those in fenestration group(P<0.05).Compared with those at 1day before surgery,AP and PT were significantly increased,F/E was reduced,ODI and VAS scores were decreased in both groups(P<0.05),and the changes were more significant in endoscope group(P<0.05).Conclusion:Compared with fenestration discectomy,percutaneous transforaminal spinal endoscopy has better perioperative indexes,biomechanics scores of lumbar dorsal muscles,dysfunction index score,postoperative pain score and incidence of complications in patients with lumbar disc herniation.