经皮内镜下椎间孔椎间盘切除术治疗L_(5)-S_(1)腰椎间盘突出症及髂嵴高度对其临床疗效的影响

Effect of percutaneous endoscopic foraminal discectomy on clinical outcome of L_(5)-S_(1) lumbar disc herniation and influence of iliac crest height on clinical efficacy

目的分析L_(5)-S_(1)腰椎间盘突出症(LDH)应用经皮内镜下椎间孔椎间盘切除术(PETD)治疗的效果,并探讨髂嵴高度对其疗效的影响。方法择取2019年2月至2022年2月收治的行PETD治疗LDH(L_(5)-S_(1)节段)患者86例,基于髂嵴高度与L_(4-5)椎弓根位置关系进行分组,将髂嵴最高点位于L_(5)椎弓根上边缘下方的48例患者纳入为A组、髂嵴最高点位于L_(4)椎弓根下缘与L_(5)椎弓根上边缘之间的33例患者纳入为B组、髂嵴最高点位于L_(4)椎弓根下缘上方的5例患者纳入为C组。比较3组手术情况及手术前后不同时点[术前(T_(0))、术后1周(T_(1))、术后1、6、12个月(T_(2)、T_(3)、T_(4))]视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果3组手术手术时间、术中出血量差异无统计学意义(P>0.05)。T_(0)时,三组VAS评分、ODI比较差异无统计学意义(P>0.05);T_(1)-T_(4)时,3组VAS评分、ODI均低于T_(0)时,A、B组均低于C组(P<0.05),但A、B组间差异无统计学意义(P>0.05)。结论PETD治疗L_(5)-S_(1)节段LDH临床疗效显著,髂嵴高度是否高于L_(4)椎弓根下缘水平线会对其临床疗效造成影响。

Objective To investigate the effect of percutaneous endoscopic transforaminal discectomy(PETD)on L_(5)-S_(1) lumbar disc herniation(LDH)and the influence of iliac crest height on the clinical efficacy.Methods A total of 86 patients treated with PETD for LDH(L_(5)-S_(1) segment)from February 2019 to February 2018 were selected and grouped according to the relationship between the highest point of the iliac crest and the position of the L_(4-5) pedicle.Forty-eighty patients with the highest point of the iliac crest located below the upper edge of the L_(5) pedicle were included in group A;thirty-three patients with the highest point of the iliac crest located between the lower edge of the L_(4) pedicle and the upper edge of the L_(5) pedicle were included in group B,and five patients with the highest point of the iliac crest located above the lower edge of the L_(4) pedicle were included in group C.The operation indexes of the three groups were compared.The visual analogue score(VAS)and Oswestry Disability index(ODI)before and after surgery[preoperative(T_(0)),1 week after surgery(T_(1)),1 month,6 months and 12 months after surgery(T_(2),T_(3),T_(4))]were compared among the three groups.Results There was no difference in operation time and blood loss among the three groups(P>0.05).At T_(0),there was no difference in VAS score and ODI among the three groups(P>0.05).At T_(1)-T_(4),when VAS score and ODI of the three groups were lower than that at T_(0),VAS in group A and B was lower than that in group C(P<0.05),but there was no difference between group A and B(P>0.05).Conclusion PETD has significantly clinical efficacy in the treatment of L_(5)-S_(1) LDH,and whether the iliac crest height is higher than the level of the lower edge of the L_(4) pedicle will affect its clinical efficacy.