显微内窥镜下髓核摘除纤维环缝合治疗腰椎间盘突出症的疗效分析

Microendoscopic lumbar discectomy combined with annulus suture in lumbar disc herniation

中文关键词:  腰椎间盘突出症  显微内窥镜下椎间盘髓核摘除术  纤维环缝合

英文关键词:Lumbar disc herniation  Microendoscopic discectomy  Annulus suture

中文摘要:

  【摘要】 目的：评价显微内窥镜下腰椎间盘髓核摘除联合纤维环缝合治疗腰椎间盘突出症（LDH）的安全性、临床疗效以及术后复发率。方法：回顾性分析我院2012年3月~2014年3月接受显微内窥镜下腰椎间盘髓核摘除术（MED）治疗的290例单节段LDH患者，男160例，女130例，年龄20~66岁（38.1±12.1岁）。其中172例单纯行MED（对照组），118例行MED联合纤维环缝合术（缝合组）。两组患者的年龄、性别比、体重指数、手术节段、突出类型及随访时间无法无统计学差异（P＞0.05），记录两组患者手术时间、出血量、术前及随访时疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）。利用影像学资料测量术前及随访时手术节段椎间隙高度。结果：两组患者平均手术时间和平均手术出血量比较均无统计学差异（P＞0.05）。随访24～32个月（28.35±5.08个月），两组组内ODI评分、腰痛VAS评分、下肢痛VAS评分术前与术后3个月、末次随访时比较均有统计学差异（P＜0.05），同时间点两组间比较无统计学差异（P＞0.05）。对照组末次随访时椎间隙高度（8.29±1.43mm）较术前（10.34±1.74mm）降低19.83%，缝合组末次随访椎间隙高度（8.94±1.35mm）较术前（10.46±1.55mm）降低14.53%，两组组间比较无统计学差异（P>0.05）。对照组术后同节段复发14例，复发率为8.14％，再手术患者6例，再手术率3.49%；缝合组术后3例患者复发，复发率为2.54％，再手术患者1例，再手术率为0.85%。两组复发率和再手术率比较有统计学差异（P<0.05）。结论：显微内窥镜下椎间盘髓核摘除纤维环缝合术治疗LDH操作简便、安全可行，可获得满意的临床疗效；在严格把握适应证的条件下，可有效降低术后复发率及再手术率。

英文摘要:

  【Abstract】 Objectives: To investigate the safety, clinical efficacy and recurrence rate of microendoscopic lumbar discectomy(MED) combined with annulus suture in the treatment of lumbar disc herniation. Methods: A total of 290 patients with lumbar disc herniation, who were treated with MED in Department of Spinal Surgery from March 2012 to March 2014, were followed up and analyzed. There were 160 males and 130 females, with a mean age of 38.1±12.1 years. This study included 118 cases of MED combined with annulus suture(suture group) and 172 cases of MED(control group). The followings were recorded: height of disc space, operation time, blood loss, scores of Oswestry disability index(ODI) and visual analogue scale(VAS). Results: There was no significant difference between the two groups in the average operation time or blood loss. All cases had been followed up for an average of 28.35±5.08 months(ranging from 24 to 32 months)． In both groups, the ODI and VAS scores significantly decreased form the pre-operation to the 3 months follow-up and the last follow-up(P<0.05); but no significant difference was observed between the two groups(P>0.05). On average, the disc height reduced by 19.83%(8.29±1.43mm to 10.34±1.74mm) from the pre-operation to the last follow-up in control group. In suture group, the disc height reduced by 14.53%(8.94±1.35mm to 10.46±1.55mm), while the difference was not statistically significant between the two groups(F=1.461, P=0.230). There were 14 cases of recurrence after operation in control group and 3 cases in suture group. Among them, 6 patients in control group received surgery again and 1 patient in suture group. The recurrence rate was 8.14% in control group and 2.54% in suture group. The reoperation rate was 3.49% in control group and 0.85% in suture group. The two groups displayed significant difference in the recurrence rate(χ2=3.973, P=0.046) and reoperation rate. Conclusions: These findings indicate that MED combined with annulus suture is safe, feasible, and simple to operate. Compared with discectomy alone, additional annulus suture can obtain equivalent and remarkable clinical outcomes. The recurrent rate and reoperation rate are reduced significantly if the procedure is performed in patients with certain surgical indications.