[1]康鹏程 陈良龙** 成世高 蒋栋 李昭 刘路星 李辉 肖炯哲.显微镜与经椎板间内镜治疗L5/S1椎间盘突出症的疗效对比[J].中国微创外科杂志,2022,01(1):19-25.
　Kang Pengcheng,Chen Lianglong,Cheng Shigao,et al.Comparison of Efficacy of L5/S1 Intervertebral Disc Herniation Operation Under Microscopic and Percutaneous Endoscopic Interlaminar Approaches[J].Chinese Journal of Minimally Invasive Surgery,2022,01(1):19-25.
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显微镜与经椎板间内镜治疗L5/S1椎间盘突出症的疗效对比()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年1期
页码:
19-25
栏目:
临床研究
出版日期:
2022-04-07

文章信息/Info

Title:
Comparison of Efficacy of L5/S1 Intervertebral Disc Herniation Operation Under Microscopic and Percutaneous Endoscopic Interlaminar Approaches
作者:
康鹏程 陈良龙** 成世高 蒋栋 李昭 刘路星 李辉 肖炯哲
（湖南省娄底市中心医院脊柱外科，娄底417100）
Author(s):
Kang Pengcheng;  Chen Lianglong;  Cheng Shigao;  et al.
Department of Spine Surgery,Central Hospital of Loudi, Loudi 417100, China
关键词:
显微镜下椎间盘切除术; 经椎板间内镜下椎间盘切除术; 椎间盘突出症
Keywords:
Microsurgical lumbar discectomy; Percutaneous endoscopic interlaminar discectomy; Disc herniation
文献标志码:
A
摘要:
目的比较显微镜下椎间盘切除术（microsurgical lumbar discectomy，MSLD）与经椎板间内镜下椎间盘切除术(percutaneous endoscopic interlaminar discectomy，PEID)治疗L5/S1椎间盘突出症的临床疗效。方法对2015年12月～2018年12月我院98例L5/S1椎间盘突出症进行回顾性分析，其中79例（80.6%）获得至少12月随访，根据手术方式分为MSLD组（n=38）和PEID组（n=41），比较2组手术时间、透视次数、疼痛视觉模拟评分(Visual Analogue Scale，VAS)、日本骨科学会（Japanese Orthopaedic Association，JOA）评分、Oswestry功能障碍指数（Oswestry Disability index，ODI）、改良MacNab标准评价临床疗效和术前、术后12个月L5/S1腰椎活动度（range of motion，ROM）、椎间隙高度。结果与PEID组比较，MSLD组手术时间明显缩短［（75.5±6.1）min vs.（82.2±8.1）min，t=-4.154，P=0.000］、透视次数明显减少［（2.0±08）次 vs.（4.1±0.9）次,t=-12.915，P=0.000］。MSLD组和PEID组并发症发生率分别为10.5％（4/38）、22.0％（9/41），差异无统计学意义（χ2=1.872，P=0.171）。2组腰腿痛VAS评分、JOA评分和ODI术后较术前显著降低（P=0.000），2组间差异无统计学意义（P＞0.05）。术后12个月MSLD组和PEID组改良MacNab标准优良率分别为92.1%（35/38）和902%（37/41），2组差异无统计学意义（Z=-0.267，P=0.789）。2组术后12个月L5/S1腰椎ROM、椎间隙高度术前差异无统计学意义（P＞0.05）。结论MSLD和PEID治疗L5/S1椎间盘突出症均获得良好的疗效，对脊柱稳定性影响小，但MSLD较PEID手术时间短、透视次数少。
Abstract:
ObjectiveTo compare the clinical efficacy of L5/S1 intervertebral disc herniation operation under microscopic and percutaneous interlaminar approaches.MethodsA retrospective study was made on 98 L5/S1 intervertebral disc herniation patients who received the treatment in our department from December 2015 to December 2018. A total of 79 patients (80.6%) were followed up for at least 1 year. According to different surgical methods, the patients were divided into microscopic lumbar discectomy group (MSLD group, n=38) and percutaneous endoscopic interlaminar discectomy group (PEID group, n=41). The Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) Scores, Oswestry disability index (ODI) and modified MacNab were used for clinical efficacy evaluation. The spinal stability was evaluated by comparing the patients’ L5/S1 lumbar vertebrae range of motion (ROM) and intervertebral space altitude before the operation and at 12 months after the operation. ResultsCompared with the PEID group, less operation time ［(75.5±6.1) min vs. (82.2±8.1) min, t=-4.154, P=0.000］ and less fluoroscopy times ［(2.0±0.8) times vs. (4.1±0.9) times, t=-12.915, P=0.000］ were seen in the MSLD group. The complication rates were 10.5% (4/38) in the MSLD group and 22.0% (9/41) in the PEID group, without statistical significance (χ2=1.872, P=0171). The VAS of lumbocrural pain, JOA Scores and ODI after the operation were markedly lower than those preoperation in both groups (P=0.000), but there was no statistical significance in the difference between the MSLD group and PEID group (P＞005). According to the modified MacNab standard, the excellentorfine rates at the 1year followup were 92.1%(35/38) in the MSLD group and 90.2%(37/41) in the PEID group, respectively, without statistical significance (Z=-0.267, P=0.789). Meanwhile, there was no statistical significance in the difference of L5/S1 lumbar vertebrae ROM and L5/S1 intervertebral space altitude before the operation and at 12 months after the operation (P>0.05).ConclusionsSurgical methods of MSLD and PEID have acquired favorable curative effects in the treatment of L5/S1 disc herniation. They have little effect on the stability of the spine. Compared with PEID, MSLD has advantages of shorter operation time and fewer fluoroscopy times.

参考文献/References:

[1]Koebbe CJ, Maroon JC, Abla A, et al. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus,2002,13(2):E3.
[2]Ruetten S, Komp M, Merk H, et al. Fullendoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976),2008,33(9):931-939.
[3]曾建成,陈果,宋跃明,等.经皮内镜椎板间入路微创治疗游离脱垂型L5～S1椎间盘突出症.中国骨与关节杂志,2014,13(8):590-596.
[4]Xu Z, Liu Y, Chen J. Percutaneous endoscopic interlaminar discectomy for L5-S1 adolescent lumbar disc herniation. Turk Neurosurg,2018,28(6):923-928.
[5]Corniola MV, Tessitore E, Schaller K, et al. Lumbar disc herniationdiagnosis and treatment. Rev Med Suisse,2014,10(454):2376-2382.
[6]Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine(Phila Pa 1976),2010,35(11):E488-E504.
[7]Kolcun J, Chieng LO, Madhavan K, et al. Minimallyinvasive versus conventional repair of spondylolysis in athletes: A review of outcomes and return to play.Asian Spine J,2017,11(5):832-842.
[8]Park Y, Ha JW, Lee YT,et al. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis and degenerative spondylosis: 5year results. Clin Orthop Relat Res,2014,472(6):1813-1823.
[9]王洪伟,孙连星,段洪凯,等.显微镜辅助下小切口治疗腰椎间盘突出症.中国微创外科杂志,2013,13(1):56-58.
[10]王本杰,赵德伟,芦健民,等.显微外科微创技术与传统手术治疗腰椎间盘突出症的比较观察.中华显微外科杂志,2011,34(3):182-184.
[11]Ebraheim NA, Miller RM, Xu R,et al. The location of the intervertebral lumbar disc on the posterior aspect of the spine. Surg Neurol,1997,48(3):232-236.
[12]胡炜,阚顺利,曹泽岗,等.三种微创术式治疗L5/S1腰椎间盘突出的临床疗效比较.中华解剖与临床杂志,2018,23(3): 190-197.
[13]黄保华,钟远鸣.脊柱内镜治疗复发性腰椎间盘突出症的进展.中国微创外科杂志,2019,19(7):637-640.
[14]OmidiKashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J,2014,8(4):521-530.
[15]Lu WW, Luk KD, Ruan DK, et al. Stability of the whole lumbar spine after multilevel fenestration and discectomy. Spine (Phila Pa 1976),1999,24(13):1277-1282.
[16]Goh JC, Wong HK, Thambyah A, et al. Influence of PLIF cage size on lumbar spine stability. Spine (Phila Pa 1976),2000, 25(1):35-40.
[17]赵晓东,邓立明,王建波,等.椎间孔镜与椎间盘镜治疗腰椎间盘突出症5年疗效比较.中国微创外科杂志,2019,19(8):684-687,701.
[18]Harrison DE, Cailliet R, Harrison DD, et al. Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine (Phila Pa 1976),2001,26(11):E227-E234.
[19]胡海刚,谭伦.脊柱矢状曲度的测量及临床意义.中国矫形外科杂志,2011,19(2):116-119.
[20]侯树勋,李明全,白巍,等.腰椎髓核摘除术远期疗效评价.中华骨科杂志,2003,23(9):4-7.

备注/Memo

备注/Memo:
基金项目：湖南省自然科学基金科卫联合项目（2020JJ8028）**通讯作者，Email：728887618@qq.com
更新日期/Last Update: 2022-04-07