经皮内窥镜下腰椎间盘切除术治疗成人单节段和双节段腰椎间盘突出合并坐骨神经性脊柱侧弯的疗效分析

Effect of percutaneous endoscopic lumbar discectomy for single and double segment lumbar disc herniation with sciatic scoliosis in adults

目的比较经皮内窥镜下腰椎间盘切除术(PELD)治疗成人单节段和双节段腰椎间盘突出(LDH)合并坐骨神经性脊柱侧弯(SS)的疗效。方法将2021年1月至2023年5月在恩施土家族苗族自治州中心医院接受PELD治疗的120例LDH合并SS患者纳入本次回顾性研究,根据手术节段数分为单节段组(n=79)和双节段组(n=41)。比较两组围手术期参数(手术时间、术中透视次数、术中出血量和术后住院时间),术前及术后3、12个月的视觉模拟评分法(VAS)、骨盆功能障碍指数(ODI)、日本骨科协会(JOA)评分,术后3、12个月的改良Macnab评价优良率及影像学参数[术前的骨盆入射角(PI),术前及术后3个月和12个月的Cobb角、胸椎后凸角(TKA)、腰椎前凸角(LLA)、顶椎偏距(AVT)、冠状面平衡(CBD)、矢状面垂直轴(SVA)及术后3、12个月的脊柱侧弯恢复正常率(RR)]。结果双节段组的手术时间、术中透视次数、术中出血量分别为(112.65±20.07)min、(9.10±3.20)次和(12.40±3.85)mL,均明显多于单节段组[(66.48±23.45)min、(5.20±2.10)次、(7.54±3.50)mL],差异均有统计学意义(P<0.05);两组的术后住院时间比较,差异无统计学意义(P>0.05)。两组术后3、12个月的VAS评分、ODI指数和JOA评分比较,差异均无统计学意义(P>0.05)。两组术后3、12个月的改良MacNab标准评价优良率比较,差异均无统计学意义(P>0.05)。单节段术前组PI为(48.60±3.51)°,高于双节段组[(37.22±2.94)°],差异有统计学意义(P<0.05);双节段组术后12个月的AVT、CBD和SVA分别为(5.26±1.90)、(5.20±1.85)、(13.55±3.31)mm,均显著高于单节段组[(2.47±1.07)、(1.49±0.62)、(6.08±2.83)mm],差异均有统计学意义(P<0.05);两组术后3、12个月的Cobb角、TKA、LLA和RR比较,差异均无统计学意义(P>0.05)。结论PELD是治疗单节段和双节段LDH合并SS的有效方法,双节段手术时间更长,术中透视次数和术中出血量更多,双节段患者与单节段患者临床疗效相似,患者术后12个月内脊柱侧弯自然矫正,也可显著改善矢状曲线,双节段患者冠状面和矢状面平衡的改善可能需要更长的时间。

Objective To compaere the efficacy of percutaneous endoscopic lumbar discectomy(PELD)for single and double segment lumbar disc herniation(LDH)with sciatic scoliosis(SS)in adults.Methods One hundred and twenty patients with LDH with SS receiving PELD at The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture Hospital from January 2021 to May 2023 were included in this retrospective study and divided into the single segment group(n=79)and the double segment group(n=41)according to the number of surgical segments.The perioperative parameters(including operation time,intraoperative fluoroscopy times,intraoperative blood loss and postoperative hospital stay),visual analogue scale(VAS),pelvic dysfunction index(ODI),Japanese Orthopedic Association score(JOA)before surgery,3 and 12 months after surgery,excellent rate of modified MacNab at 3 and 12 months after surgery,imaging parameters[including the pelvic incidence(PI)before surgery,Cobb angle,thoracic kyphosis angle(TKA),lumbar lordosis angle(LLA),apical vertebral translation(AVT),coronal balance distance(CBD),sagittal vertical axis(SVA)before surgery,3 and 12 months after surgery,and the rate of scoliosis recovery(RR)at 3 and 12 months after surgery were compared].Results The operation time,intraoperative fluoroscopy times,and intraoperative blood loss of the double segment group group were(112.65±20.07)min,(9.10±3.20)times,and(12.40±3.85)mL,respectively,much higher than those of the single segment group[(66.48±23.45)min,(5.20±2.10)times,(7.54±3.50)mL],the differences were statistically significant(P<0.05);there was no statistically significant difference in postoperative hospital stay between the two groups(P>0.05).there were no statistically significant differences in the VAS score,ODI index,and JOA score at 3 and 12 months after surgery between the two groups(P>0.05).There was no significant difference in the excellent and good rate of modified MacNab standard evaluation at 3 and 12 months after surgery between the two groups(P>0.05).Before surgery,the PI of the single-segment group was(48.60±3.51)°,which was higher than that of the double-segment group[(37.22±2.94)°],and the difference was statistically significant(P<0.05).The AVT,CBD,and SVA of the double segment group group at 12 months after surgery were(5.26±1.90),(5.20±1.85),and(13.55±3.31)mm,respectively,which were higher than those of the single segment group[(2.47±1.07),(1.49±0.62),and(6.08±2.83)mm],the differences were statistically significant(P<0.05).There were no significant differences in Cobb angle,TKA,LLA and RR at 3 and 12 months after surgery between the two groups(P>0.05).Conclusion PELD is an effective method for treating single and double segment LDH with SS.Dual segment surgery takes longer,with more intraoperative fluoroscopy and blood loss.The clinical efficacy of double segment patients is similar to that of single segment patients.Within 12 months after surgery,the sagittal curve was significantly improved in both groups.The improvement of coronal and sagittal balance in double-segment patients may take longer.