新型三轴调节式定位器辅助经皮椎间孔镜手术治疗多节段腰椎间盘突出症效果及初步随访

Effect and preliminary follow-up of percutaneous foraminal endoscopic discectomy assisted by a novel three-axis adjustable positioner for multi-segment lumbar disc herniation

目的探讨新型三轴调节式定位器辅助经皮椎间孔镜手术(percutaneous transforaminal endoscope discectomy,PTED)治疗多节段腰椎间盘突出症(lumber disc herniation,LDH)效果及随访结果。方法选取我院100例多节段LDH患者,简单随机化法分组,各50例。对照组行传统PTED,观察组行新型三轴节式定位器辅助PTED。观察对比2组围术期指标、并发症、手术优良率及手术前后炎症应激指标[白细胞介素2(interleukin-2,IL-2)、白细胞介素6(interleukin-6,IL-6)、白细胞介素17(interleukin-17,IL-17)]、患侧多裂肌表面肌电图[均方根值(root mean square,RMS)、中位频率值(median frequencyMF)、积分肌电值(integrated EMG,IEMG)]、Oswestry功能障碍指数问卷表(Oswestry dysfunction index,ODI)评分、视觉模拟评分法(visual analogue scale,VAS)评分及手术优良率。结果观察组透视次数、穿刺次数、术中出血量少于对照组,穿刺时间、手术时间短于对照组,一次性穿刺成功率高于对照组(P<0.05);2组并发症发生率比较差异无统计学意义(P>0.05);术后1 d观察组血清IL-17、IL-6、IL-2水平低于对照组(P<0.05);术后1个月、3个月、6个月、12个月2组患侧多裂肌RMS、MF、IEMG均高于术前,ODI评分均低于术前(P<0.05);术后1 d、5 d观察组腰背部、下肢VAS评分低于对照组(P<0.05);术后12个月2组手术优良率比较,差异无统计学意义(P>0.05)。结论新型三轴调节式定位器辅助PTED与传统PTED治疗多节段LDH均能取得满意效果,能改善患侧多裂肌表面肌电图,恢复腰椎功能,缓解患者疼痛,且具有较好安全性,但前者能优化手术操作,缩短手术时间,减轻术后炎症反应,有助于早期疼痛缓解。

Objective To investigate the effect and follow-up results of percutaneous foraminal endoscopic discectomy(PTED)assisted by a novel three-axis adjustable positioner in the treatment of multi-segment lumbar disc herniation(LDH).Methods A total of 100 patients with multi-segment LDH in our hospital were selected and divided into two groups by simple randomization method,with 50 patients in each group.The control group received traditional PTED,and the observation group received PTED assisted by a novel three-axis adjustable positioner.Perioperative indexes,complications,excellent and good rate of surgery,inflammatory stress indexes[interleukin-2(IL-2),interleukin-6(IL-6),interleukin-17(IL-17)],surface electromyography[root mean square(RMS)value,median frequency(MF)value,integrated electromyography(IEMG)of multifidus muscle on the affected side],Oswestry Disability Index(ODI)score,visual analog scale(VAS)score,and excellence and good rate of surgery of the two groups before and after surgery were observed and compared.Results The number of fluoroscopy,puncture times and intraoperative blood loss in the observation group were less than those in the control group,the puncture time and duration of operation were shorter than those in the control group,and the success rate of one-time puncture was higher than that in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).The serum levels of IL-17,IL-6 and IL-2 in the observation group were lower than those in the control group at 1 d after surgery(P<0.05).RMS,MF and IEMG of multifidus muscle on the affected side were higher than those before surgery,and at 1 month,3 months,6 months and 12 months after surgery,while ODI scores were lower than those before surgery(P<0.05).The VAS scores of the lower back and lower limbs in the observation group were lower than those in the control group at 1 and 5 d after surgery(P<0.05).At 12 months after surgery,there was no significant difference in excellent and good rate of surgery between the two groups(P>0.05).Conclusion The novel three-axis adjustable positioner assisted PTED and traditional PTED can achieve satisfactory results in the treatment of multi-segment LDH,which can improve the surface electromyography of the multifidus muscle on the affected side,restore the function of the lumbar spine,relieve the pain of patients,and has good safety.However,the former can optimize the operation,shorten the duration of operation,reduce postoperative inflammation,and contribute to early pain relief.