偏心环锯技术辅助椎间孔镜治疗腰椎间盘突出伴侧隐窝狭窄症的临床疗效

Clinical efficacy of eccentric trephine technique assisted percutaneous transforaminal endoscopic discectomy for the treatment of lumbar lateral recess stenosis

目的探讨偏心环锯技术辅助椎间孔镜治疗腰椎间盘突出伴侧隐窝狭窄症的临床疗效。方法选取湖北省第三人民医院疼痛科2017年9月至2020年9月进行椎间孔镜治疗L_(4)及L_(5)~S_(1)节段腰椎间盘突出伴侧隐窝狭窄的患者50例,采用随机数字表法分为传统孔镜组和偏心环锯技术组,每组25例。传统孔镜组使用传统椎间孔镜手术方法扩张椎间孔后放置工作套管并行椎间孔镜手术,偏心环锯技术组使用偏心环锯技术扩张椎间孔后置入工作套管并行椎间孔镜手术。比较两组患者手术前,手术后2、30d及1年的疼痛视觉模拟评分(VAS)与日本骨科协会(JOA)评估治疗分数。采用改良后MacNab标准评定患者总体疗效及术后30d、1年的优良率。结果与治疗前比较,两组患者各观察时点VAS评分均明显下降、JOA评分均明显升高,差异均有统计学意义(P均<0.05)。术后2d偏心环锯技术组VAS评分明显低于传统孔镜组,差异有统计学意义(P<0.05)。术后2、30d偏心环锯技术组JOA评分明显高于传统孔镜组,差异有统计学意义(P<0.05)。偏心环锯技术组术后30d治疗优良率为92.0%(23/25例),显著优于传统孔镜组68%(17/25例),差异有统计学意义(P<0.05);术后1年治疗优良率为96.0%(24/25例),与传统孔镜组88.0%(22/25例)无明显差异(P>0.05)。结论偏心环锯技术辅助椎间孔镜治疗腰椎间盘突出伴侧隐窝狭窄症是一种有效的方法。

ObjectiveTo investigate the clinical efficacy of transforaminal endoscopic discectomy assisted by eccentric trephine in the treatment of lumbar disc herniation with lateral recess stenosis.Methods Fifty patients,with lumbar disc herniation and lateral recess stenosis at L_(4) and L_(5)~S_(1),and underwent transforaminal endoscopic surgery,from September 2017 to September 2020 in the Department of Painology of the Third People's Hospital of Hubei Province,were randomly divided into traditional endoscopic group and eccentric trephine group by a random number table,with 25 cases in each group.The traditional endoscopic group used the traditional foraminoscope surgical method to dilate the intervertebral foramen and placed a working cannula for foraminoscope surgery.The eccentric trephine group used the eccentric trephine technique to dilate the intervertebral foramen and placed a working cannula for foraminoscope surgery.Visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)scores were compared between the two groups before the operation,and 2 days,30 days and 1 year after the operation.The overall efficacy,the excellent and good rate were evaluated by the modified MacNab criteria at 30 days and 1 year after the operation.Results Compared with before the operation,VAS were significantly decreased and JOA scores were significantly increased in both groups at each observation time point(all P<0.05).The VAS were significantly lower in the eccentric trephine group than that in the traditional endoscopic group,at 2 days after the operation(P<0.05).The JOA scores were significantly higher in the eccentric trephine group than that in the traditional endoscopic group,at 2 and 30 days after the operation(P<0.05).The excellent and good rate were 92.0%(23/25 cases)in the eccentric trephine group and 68.0%(17/25 cases)in the traditional endoscopic group at 30 days after the operation(P<0.05).One year after the operation,the excellent and good rate were 96.0%(24/25 cases)in the eccentric trephine group and 88.0%(22/25 cases)in the traditional endoscopic group(P>0.05).Conclusion Transforaminal endoscopic discectomy assisted by eccentric trephine is an effective method in the treatment of lumbar disc herniation with lateral recess stenosis.