在椎间孔镜下单节段髓核摘除术治疗多节段腰椎间盘突出症的疗效

Effect of treatment of multi-segment lumbar disc herniation by single segment percutaneous endoscopic lumbar discectomy

摘要:

【】目的：研究多节段腰椎间盘突出症患者行椎间孔镜下单节段髓核摘除术的疗效。方法：回顾分析2015年9月至2018年3月间住院治疗的多节段腰椎间盘突出患者75例,通过椎间盘造影确定责任间盘,行椎间孔镜下单节段(责任间盘)髓核摘除术,比较术前与术后6个月的VAS评分、Oswestry功能障碍指数(ODI),并通过MacNab标准来评价手术疗效。结果：75例患者通过椎间盘造影的诱发痛情况分为三组,其中单节段诱发痛组25例(S组),双节段诱发痛组25例(D组),无诱发痛组25例(N组)。所有患者均行单节段椎间孔镜下髓核摘除术,术后均无感染、血肿、神经损伤等并发症,术后至少随访6个月。三组患者术后6个月VAS评分、ODI指数与术前相比有统计学意义(P<0.05),三组患者间术后6个月VAS评分、ODI指数的差异无统计学意义(P>0.05)。术后改良MacNab疗效评定：S组(优17例,良5例,可3例,差0例,优良率88.0%),D组(优11例,良10例,可3例,差1例,优良率84.0%),N组(优15例,良7例,可1例,差2例,优良率88.0%),三组患者间术后优良率差异无统计学差异(P>0.05)。结论：对于大多数的多节段腰椎间盘突出症患者,行椎间孔镜下单节段髓核摘除术可取得良好的远期疗效。

Abstract:

Objective: To study the effect of single-segment percutaneous endoscopic lumbar discectomy in patients with multi-segment lumbar disc herniation. Methods: 75 patients with multi-segment lumbar disc herniation who were hospitalized from September 2015 to March 2018 were retrospectively analyzed. Responsible disc was confirmed by discography. Single-segment (responsible disc) percutaneous endoscopic lumbar discectomy was performed. visual analog scale (VAS) and Oswestry disability index (ODI) at 6 months after operation were compared with those before operation. MacNab criteria were used to evaluate surgical outcome. Results: 75 patients were divided into three groups through induced pain caused by discography, including 25 cases in single segment induced pain group (S group), 25 cases in double segment induced pain group (D group) and 25 cases in non-induced pain group (N group). All patients underwent single-segment percutaneous endoscopic lumbar discectomy. There were no complications such as infection, hematoma, nerve injury and so on. All patients were followed up for at least 6 months. The VAS and ODI of each group at 6 months after operation were significantly different from those before operation (P<0.05). There was no significant difference in VAS and ODI between the three groups at 6 months after operation (P>0.05). Postoperative MacNab criteria: group S (excellent 17 cases, good 5 cases, fair 3 cases, poor 0 cases, excellent and good rate 88.0%), group D (excellent 11 cases, good 10 cases, fair 3 cases, poor 1 case, excellent and good rate 84.0%), group N (excellent 15 cases, good 7 cases, fair 1 case, poor 2 cases, excellent and good rate 88.0%). There was no significant difference in the excellent and good rate among the three groups (P>0.05). Conclusion: For the majority of patients with multi-level lumbar disc herniation, single-segment percutaneous endoscopic lumbar discectomy can achieve good long-term results.