侧隐窝注射术与脊柱内镜手术治疗微小腰椎间盘突出症的疗效对比研究*

Comparison of lateral recess injection with spinal endoscopic surgery for the treatment of minimal lumbar disc herniation*

摘要:

目的：比较侧隐窝注射术(Lateral Recess Injection, LRI)与椎间孔入路经皮脊柱内镜腰椎间盘摘除术(Percutaneous Endoscopic Transforaminal Discectomy, PETD)治疗微小腰椎间盘突出症(Minimal Lumbar Disc Herniation, MLDH)的临床疗效。方法：回顾性分析2023年5月至2024年5月南昌大学第一附属医院疼痛科收治的MLDH患者信息,根据患者接受的治疗方式不同将其分为PETD组(30例)和LRI组(30例)。记录两组患者住院天数、住院费用、治疗后并发症等信息,在术前1天、术后3天、术后3月、术后6月时使用疼痛视觉模拟量表(visual analogue scale, VAS)、Oswestry 功能障碍指数(Oswestry Disability Index, ODI)评估患者情况,并在术后3天与术后6月以改良MacNab标准评价临床疗效。结果：MLDH患者大部分表现为腰痛及一侧臀腿的放射痛,性质多为酸胀痛,影像显示突出髓核平均直径为3.51mm,无明显钙化,多位于L4-5节段,MSU分区以B区为主。两组患者术后各时间点VAS、ODI评分较术前均有明显下降(P < 0.05),PETD组术后各时间点VAS、ODI评分明显低于LRI组(P < 0.05)。术后3天两组疗效无明显差异,术后6月PETD组优良率(93.33%)高于LRI组(73.33%),差异显著(P < 0.05)；除PETD组有1例患者出现复发外,其余患者均未见并发症,两组并发症发生率无统计学差异；两组患者住院天数无明显差异,但PETD组住院费用高于LRI组(P < 0.05)。结论：MLDH患者具有突出微小、神经根受压为主、腰腿痛剧烈及病程较短等特点,应结合临床表现与影像结果进行综合诊断。LRI与PETD均能安全有效治疗MLDH,前者具有经济便捷、操作难度较低等优势,而后者在疼痛缓解、功能改善及长期疗效稳定性等方面表现更为突出。

Abstract:

Objective: To compare the clinical efficacy between lateral recess injection(LRI) and percutaneous endoscopic transforaminal discectomy(PETD) in treating minimal lumbar disc herniation(MLDH).Methods:Retrospectively analyzed clinical data from MLDH patients treated in the Department of Pain at The First Affiliated Hospital of Nanchang University from May 2023 to May 2024. Patients were divided into PETD group(n=30) and LRI group(n=30) based on treatment methods. Data on Hospital stay duration, hospitalization costs, and treatment-related complications were systematically documented for both groups.Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate patient condition at 1 day before operation, 3 days, 3 months and 6 months after operation, respectively.The clinical efficacy was evaluated by the modified MacNab criteria at 3 days and 6 months after the operation.Results:MLDH patients predominantly presented with low back pain and unilateral radiating leg pain, characterized by a dull ache. Imaging revealed an average herniated nucleus pulposus diameter of 3.51 mm, without significant calcification,primarily located at the L4-5 level, with MSU classification predominantly in Zone B. Both groups showed significant reductions in VAS and ODI scores at all postoperative time points compared to pre-operation(P < 0.05). The PETD group demonstrated significantly lower VAS and ODI scores than the LRI group at all postoperative time points (P < 0.05).While no significant difference in efficacy was observed at 3 days after operation, the PETD group achieved a higher excellent/good rate (93.33%) than the LRI group (73.33%) at 6 months after operation(P < 0.05). One recurrence occurred in the PETD group, with no other complications reported in either group, and no significant difference in complication rates between groups. Hospital stay duration was comparable between groups, but hospitalization costs were significantly higher in the PETD group (P < 0.05).Conclusion:MLDH is characterized by small herniated nucleus pulposus, significant nerve root compression, severe low back and leg pain, and a short disease course. Definitive diagnosis necessitates evaluation combining symptomatic profiles and radiological evidence. Both LRI and PETD are safe and effective treatments for MLDH. LRI offers advantages in cost-effectiveness and procedural simplicity, while PETD demonstrates superior pain relief, functional improvement, and long-term efficacy stability.