改良Pfirrmann分级系统对经皮脊柱内镜下腰椎间盘摘除术治疗腰椎间盘突出症的临床价值--基于倾向性评分匹配法*

CLINICAL VALUE OF MODIFIED PFIRRMANN GRADING SYSTEM IN THE TREATMENT OF LUMBAR DISC HERNIATION UNDER PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY: BASED ON PROPENSITY SCORE MATCHING METHOD *

摘要:

目的 评价改良Pfirrmann分级系统在经皮脊柱内镜下腰椎间盘摘除术（Percutaneous Endoscopic Lumbar Discectomy，PELD）治疗腰椎间盘突出症(Lumbar Disc Herniation, LDH)术后疗效中的临床价值。方法 收集山东大学附属省立医院疼痛科 2020年11月至2022年8月接受PELD治疗的252例LDH患者信息，术前按责任间盘改良Pfirrmann分级分为高分级组（A组）114例，低分级组（B组）138例。经倾向性评分匹配法（Propensity Score Matching, PSM）平衡两组患者的基线资料差异后，对两组患者的术前及术后7d、1、3、6个月的数字评价量表(Numerical Rating Scale, NRS)、Oswestry功能障碍指数 (Oswestry Disability Index, ODI)、匹兹堡睡眠质量指数（Pittsburgh Sleep Quality Index, PSQI）及改良 Macnab 优良率进行对比分析。结果 两组术后各时间点NRS评分、ODI评分及PSQI评分均较术前明显改善（P＜0.05）。术后7d、1、3、6月B组NRS评分、ODI评分均低于A组（P＜0.05）；术后1、3、6月B组PSQI评分均低于A组（P＜0.01）；术后7d、1、3、6月B组的改良Macnab优良率均高于A组（P＜0.001）。结论 B组疗效明显优于A组，与PELD治疗LDH的疗效具有相关性。这对术前患者的合理选择、术后疗效的预测具有重要的临床价值。

Abstract:

Objective To assess the predictive value of the modified Pfirrmann grading system in the treatment of Lumbar Disc Herniation (LDH) by Percutaneous Endoscopic Lumbar Discectomy (PELD). Methods Information was collected on 252 LDH patients treated in the Pain Department of Shandong Provincial Hospital from November 2020 to August 2022, and they were divided into the high grade group (group A, n=114) and the low grade group (group B, n=138) according to the modified pfirrmann grading system of herniation discs. After differences of baseline data being balanced by Propensity Score Matching (PSM), the scores of Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Pittsburgh Sleep Quality Index (PSQI) and Modified Macnab excellent and good rate were compared and analyzed before surgery, 7 d after surgery, and 1, 3, 6 months after surgery. Results NRS scores, ODI scores and PSQI scores were significantly improved in both groups at difffferent time points after surgery (P<0.05). Compared with group A, the NRS scores and ODI scores were signifificantly decreased at 7 d after surgery and 1, 3, 6 months after surgery in group B (P<0.05). Compared with group A, the PSQI scores were signifificantly decreased at 1, 3, 6 months after surgery in group B (P＜0.01). Modified Macnab excellent and good rate in the B group were significantly higher than those in the A group at 7 d after surgery and 1, 3, 6 months after surgery (P<0.001). Conclusion The efficacy of the B group was significantly better than that of the A group. The modified Pfirrmann grading system is correlated with the efficacy of PELD in the treatment of LDH, which has important clinical value for the rational selection of patients before surgery and the prediction of postoperative efficacy.