椎间孔镜术中骨钻与环锯关节突成形的比较
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摘要
[目的]比较骨钻和环锯关节突成形术在后外侧入路椎间孔镜术治疗腰椎间盘突出症(LDH)的安全性和临床疗效。[方法]对2015年10月～2017年10月本科内镜手术治疗的单节段单侧LDH的54例患者进行回顾性分析,其中采用骨钻关节突成形29例,环锯成形25例。采用视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分和日本矫形外科协会(JOA)评分,以及MacNab评价标准进行两组临床疗效评价。摄腰椎椎侧位及动力位X线片,测量腰椎过屈和过伸位时的水平位移及角位移,评估腰椎稳定性。[结果]两组患者均顺利完成手术。骨钻组通道建立时间显著长于环锯组[(44.90±3.95) min vs(32.00±3.20) min,P<0.05],但镜下处理时间骨钻组少于环锯组[(32.07±4.20 min) vs(42.96±5.10 min),P<0.05]。两组的切口长度、出血量和术后住院时间差异均无统计学意义(P>0.05)。骨钻组有3例成形挤压行走根,环锯组有2例损伤出口根,致一过性感觉障碍,均未发生严重并发症。所有患者至少随访1年,均未发生椎间盘突出复发。术后3、12个月两组VAS、ODI及JOA评分均较术前显著改善(P<0.05)。术后12个月两组改良MacNab评价疗效优良率均相近(P>0.05)。影像评估方面,两组患者术后3、12个月水平位移及角位移角较术前差异无统计学意义(P>0.05)。[结论]骨钻成形和环锯成形均为椎间孔镜术治疗腰椎间盘突出症安全、有效的关节突成形方式。
[Objective] To compare the safety and clinical outcomes of bone drill versus trephine for foraminoplasty in percutaneous endoscopic transforaminal discectomy(PETD). [Methods] A retrospective study was conducted on 54 patients who underwent PETD for single segmental lumbar disc herniation(LDH) in our department from October 2015 to October 2017. Of them, 29 patients had foraminoplasty done by bone drill, while the remaining 25 patients with trephine. The perioperative data,visual analogue scale(VAS) for pain, Oswestry Disability Index(ODI), Japanese Orthopedic Association(JOA) score and grading by modified MacNab criteria, as well as intervertebral horizontal and angular displacements measured in dynamic lateral radiographs were compared between the two groups. [Results] All the patients in both group had operation performed smoothly.The drill group consumed significantly longer time to establish working channel than the trephine group [(44.90±3.95) min vs(32.00 ± 3.20) min, P<0.05], whereas the former spent significantly less time in endoscopic operation than the latter[(32.07±4.20) min vs(42.96±5.10) min,P<0.05]. There were no statistically significant differences in incision length, intraoperative blood loss, hospitalization time between the two groups(P>0.05). Except 3 patients who suffered from temporary sensory disturbance due to the outlet nerve root squeezed in the drill group and 2 patients who had the nerve root damaged in the trephine group, no serious complications happened in any of them. The patients were followed up for more than 1 year, and no recurrence of disc herniation was found in anyone. At 3 and 12 months postoperatively, the patients in both groups got statistically significant improvements in VAS, ODI and JOA scores compared with those before operation(P<0.05). At 12 months, no a significant difference was proved between the two groups in clinical results graded by by modified MacNab criteria(P>0.05). In term of radiographic measurements, the horizontal and angular displacements at 3 and 12 months postoperatively in both groups had no significant variation compared with those before operation(P>0.05). [Conclusion] Foraminoplasty by both bone drill and trephine is safe and effective in PETD for the treatment of single segmental LDH.
[Objective] To compare the safety and clinical outcomes of bone drill versus trephine for foraminoplasty in percutaneous endoscopic transforaminal discectomy(PETD). [Methods] A retrospective study was conducted on 54 patients who underwent PETD for single segmental lumbar disc herniation(LDH) in our department from October 2015 to October 2017. Of them, 29 patients had foraminoplasty done by bone drill, while the remaining 25 patients with trephine. The perioperative data,visual analogue scale(VAS) for pain, Oswestry Disability Index(ODI), Japanese Orthopedic Association(JOA) score and grading by modified MacNab criteria, as well as intervertebral horizontal and angular displacements measured in dynamic lateral radiographs were compared between the two groups. [Results] All the patients in both group had operation performed smoothly.The drill group consumed significantly longer time to establish working channel than the trephine group [(44.90±3.95) min vs(32.00 ± 3.20) min, P<0.05], whereas the former spent significantly less time in endoscopic operation than the latter[(32.07±4.20) min vs(42.96±5.10) min,P<0.05]. There were no statistically significant differences in incision length, intraoperative blood loss, hospitalization time between the two groups(P>0.05). Except 3 patients who suffered from temporary sensory disturbance due to the outlet nerve root squeezed in the drill group and 2 patients who had the nerve root damaged in the trephine group, no serious complications happened in any of them. The patients were followed up for more than 1 year, and no recurrence of disc herniation was found in anyone. At 3 and 12 months postoperatively, the patients in both groups got statistically significant improvements in VAS, ODI and JOA scores compared with those before operation(P<0.05). At 12 months, no a significant difference was proved between the two groups in clinical results graded by by modified MacNab criteria(P>0.05). In term of radiographic measurements, the horizontal and angular displacements at 3 and 12 months postoperatively in both groups had no significant variation compared with those before operation(P>0.05). [Conclusion] Foraminoplasty by both bone drill and trephine is safe and effective in PETD for the treatment of single segmental LDH.
引文
[1]周跃,李长青,王建,等.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):225-231.
[2]Dupuis PR,Yonghing K,Cassidy JD,et al.Radiologic diagnosis of degenerative lumbar spinal instability[J].Spine,1985,10(3):262-276.
[3]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[4]Ohtori S,Ito T,Yamashita M,et al.Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study:differences in scores based on age,sex,and type of disease[J].J Orthop Sci,2010,15(1):86-91.
[5]Macanab J.Negative disc exploration.An analysis of the causes of nerve-root involenent in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903
[6]Yeung AT,Tsou PM.Posterolateral endoscopic excision for lurebar disc herniation:surgical technique,outcome,and complieatioas in307 consecutive eases[J].Spine,2002,27(7):722-731.
[7]Hoogland T,Schubert M,Miklitz B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose ehymopapain:a prospective randomized study in 280consecutive cases[J].Spine,2006,31(24):890-897.
[8]陆佩.经皮椎间孔镜手术入路相关解剖学研究[D].苏州大学,2014.
[9]顾昕,贺石生,张海龙,等.经皮后外侧腰椎间孔入路椎间盘工作区域的解剖学研究[J].中华骨科杂志,2011,31(10):1033-1037.
[10]李振宙,吴闻文,侯树勋,等.侧后路经皮椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛[J].中国微创外科杂志,2009,9(4):332-335.
[11]杨晋才,海涌,关立,等.自制环锯椎间孔一次成形技术在经椎间孔入路经皮内窥镜下椎间盘切除术中的临床价值[J].脊柱外科杂志,2015,13(6):351-355.
[12]常献,刘长利,韩敦鑫,等.应用TESSYSTM椎间孔镜技术治疗L1-2椎间盘突出1例报道[J].中国矫形外科杂志,2018(1):90-92.
[13]祝斌,刘晓光.基于骨锉系统的椎间孔成形术在腰椎内镜手术中的应用[J].中国疼痛医学杂志,2016,22(1):41-44.
[14]Huang CJ,Tang FY,Liu BX,et al.Analysis of intermediate and long term clinical effects on discectomy with diskoscope[J].Chin J Orthop Traumatol,2009,22(4):251-253.
[2]Dupuis PR,Yonghing K,Cassidy JD,et al.Radiologic diagnosis of degenerative lumbar spinal instability[J].Spine,1985,10(3):262-276.
[3]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[4]Ohtori S,Ito T,Yamashita M,et al.Evaluation of low back pain using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire for lumbar spinal disease in a multicenter study:differences in scores based on age,sex,and type of disease[J].J Orthop Sci,2010,15(1):86-91.
[5]Macanab J.Negative disc exploration.An analysis of the causes of nerve-root involenent in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903
[6]Yeung AT,Tsou PM.Posterolateral endoscopic excision for lurebar disc herniation:surgical technique,outcome,and complieatioas in307 consecutive eases[J].Spine,2002,27(7):722-731.
[7]Hoogland T,Schubert M,Miklitz B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose ehymopapain:a prospective randomized study in 280consecutive cases[J].Spine,2006,31(24):890-897.
[8]陆佩.经皮椎间孔镜手术入路相关解剖学研究[D].苏州大学,2014.
[9]顾昕,贺石生,张海龙,等.经皮后外侧腰椎间孔入路椎间盘工作区域的解剖学研究[J].中华骨科杂志,2011,31(10):1033-1037.
[10]李振宙,吴闻文,侯树勋,等.侧后路经皮椎间孔镜下髓核摘除、射频热凝纤维环成形术治疗椎间盘源性腰痛[J].中国微创外科杂志,2009,9(4):332-335.
[11]杨晋才,海涌,关立,等.自制环锯椎间孔一次成形技术在经椎间孔入路经皮内窥镜下椎间盘切除术中的临床价值[J].脊柱外科杂志,2015,13(6):351-355.
[12]常献,刘长利,韩敦鑫,等.应用TESSYSTM椎间孔镜技术治疗L1-2椎间盘突出1例报道[J].中国矫形外科杂志,2018(1):90-92.
[13]祝斌,刘晓光.基于骨锉系统的椎间孔成形术在腰椎内镜手术中的应用[J].中国疼痛医学杂志,2016,22(1):41-44.
[14]Huang CJ,Tang FY,Liu BX,et al.Analysis of intermediate and long term clinical effects on discectomy with diskoscope[J].Chin J Orthop Traumatol,2009,22(4):251-253.