超声骨刀辅助下单孔分体内镜治疗钙化型腰椎间盘突出症的临床疗效

Clinical efficacy of single hole split endoscopy assisted by ultrasound bone knife in the treatment of calcified lumbar disc herniation

目的探讨钙化型腰椎间盘突出症(CLDH)采用超声骨刀辅助单孔分体内镜下椎间盘切除术(OSED)治疗的临床疗效,为临床提供参考。方法回顾性分析2022年1月—2023年2月在上海市浦东新区人民医院骨科治疗的25例CLDH患者资料,患者均应用超声骨刀辅助完成OSED。观察手术出血量、手术时间、术后下床时间、切口长度、术中透视次数及围手术期并发症等情况。比较患者术前、术后腰痛和腿痛VAS评分及Oswestry功能障碍指数(ODI);比较术前、术后3个月椎间盘CT横截面的钙化突出物面积;在末次随访时使用改良MacNab标准评估手术疗效。结果25例患者均手术顺利,未发生严重血管神经损伤的并发症。切口长度为(2.01±0.26)cm,手术用时为(87.40±12.84)min,手术出血量为(52.40±28.33)mL,术中透视次数为(2.88±1.01)次,术后下床时间为(22.56±7.80)h。患者术后各时间段腰痛、腿痛VAS评分及ODI指数较术前均明显下降(P<0.05)。与术前比较,术后3个月椎间盘CT横截面钙化物面积明显减小(P<0.001)。患者手术优良率达到92.0%(23/25)。结论应用超声骨刀辅助OSED治疗CLDH的疗效满意,具有创伤小、钙化突出物切除充分、并发症少等优势。

Objective To examine the clinical efficacy of ultrasonic osteotome-assisted one-hole split endoscopic discectomy(OSED)for calcified lumbar disc herniation(CLDH)and to provide a clinical reference point.Methods A retrospective analysis was conducted on 25 patients with CLDH who were treated at the Department of Orthopaedics in Shanghai Pudong New Area People's Hospital between January 2022 and February 2023.All patients underwent osteosynthesis with the assistance of an ultrasonic bone knife.It is crucial to meticulously observe and document the extent of surgical bleeding,the duration of the surgical procedure,the postoperative period required for patients to be able to get out of bed,the length of the incision,the frequency of intraoperative fluoroscopy,and any perioperative complications.A comparison of the visual analogue scale(VAS)and Oswestry disability Index(ODI)scores for low back pain and leg pain before and after surgery will be conducted.Furthermore,the area of calcified protrusions on the CT cross-section of intervertebral discs before and three months after surgery will be evaluated.Finally,the modified MacNab criteria will be employed to evaluate the surgical efficacy at the conclusion of the follow-up period.Results All 25 patients underwent surgical intervention without any significant complications,including vascular or nerve injury.The mean length of the incision was(2.01±0.26)cm,the mean surgical time was(87.40±12.84)min,the mean surgical bleeding volume was(52.40±28.33)mL,the mean frequency of intraoperative fluoroscopy was(2.88±1.01)times,and the mean postoperative time to get out of bed was(22.56±7.80)h.The VAS score and ODI index for lower back pain and leg pain in patients at different time points after surgery exhibited a statistically significant reduction compared to the pre-surgical period(P<0.05).Moreover,the area of calcified material in the CT cross-section of the intervertebral disc demonstrated a significant reduction at the three-month post-surgical mark in comparison to the pre-surgical level(P<0.001).The proportion of patients who were rated as excellent or good using the revised MacNab criteria was 92.0%(23/25).Conclusion The application of ultrasonic osteotome assisted OSED in the treatment of CLDH has satisfactory therapeutic effects,with advantages such as minimal trauma,sufficient removal of calcified protrusions,and fewer complications.