显微镜辅助腰椎减压融合内固定术治疗复发性腰椎间盘突出症的安全性

Safety analysis of microscope-assisted lumbar interbody decompression, fusion and internal fixation in the treatment of recurrent lumbar disc herniation

中文关键词:  腰椎间盘突出症  显微镜  翻修手术

英文关键词:Lumbar disc herniation  Microscope  Revision surgery

中文摘要:

  【摘要】 目的：分析显微镜辅助在腰椎减压融合内固定术治疗复发性腰椎间盘突出症中的安全性。方法：回顾性分析2020年1月1日~2022年4月1日73例在我医学中心治疗的经皮脊柱内镜下腰椎间盘摘除术（percutaneous endoscopic lumbar discectomy，PELD）术后复发的腰椎间盘突出症患者资料，所有患者复发后于我院再次行单节段腰椎减压固定融合术，其中42例术中使用显微镜辅助操作（显微镜组），男31例，女11例，年龄53.4±16.4岁；31例术中未使用显微镜辅助操作（常规组），男18例，女13例，年龄49.6±11.4岁。两组患者性别、年龄、体重指数等一般资料均无统计学差异（P>0.05）。记录两组患者首次PELD的手术入路、手术节段，翻修术手术时间、术中出血量、术后总引流量、术后住院时间、术中是否出现硬膜破损、术后是否出现神经损伤及术后伤口是否出现浅部感染等资料，比较分析两组差异。结果：所有患者手术顺利。显微镜组手术时间168.0±33.1min，术中出血量125.0±40.2mL，术后总引流量379.6±220.6mL，术后住院时间5.2±1.3d，术中出现脑脊液漏2例，术后未出现神经损伤症状及伤口浅部感染；常规组手术时间155.8±29.4min，出血量133.9±59.7mL，术后总引流量452.2±464.5mL，术后住院时间5.0±1.7d，术中出现脑脊液漏4例，术后出现神经损伤症状1例，术后未出现伤口浅部感染。两组患者围手术期及并发症相关数据均无统计学差异（P>0.05）。结论：显微镜不会增加PELD术后复发翻修手术的手术时间、术中出血量、术后住院时间以及感染、硬膜破损和神经损伤的发生率。

英文摘要:

  【Abstract】 Objectives: To analyze the safety of the assistance of microscope in lumbar interbody decompression, fusion and internal fixation in the treatment of recurrent lumbar disc herniation. Methods: Retrospective analysis was made on 73 patients recurred lumbar disc herniation after percutaneous endoscopic lumbar discectomy(PELD) and underwent a revision surgery of single-segment lumbar decompression and fusion in our hospital from January 1, 2020 to April 1, 2022. Among the patients, 42 received microscope-assisted operation(microscope group), including 31 males and 11 females, aged 53.4±16.4 years; the other 31 received an operation without microscope assistance(conventional group), including 18 males and 13 females, aged 49.6±11.4 years. There were no significant differences between the two groups in general data such as gender, age and BMI(P>0.05). Data such as the surgical approach and surgical segment of initial PELD, and operative time, intraoperative bleeding volume, total postoperative drainage volume, postoperative length of stay, dural tears, nerve injury and superficial infection of the revision surgery were collected and compared between the two groups. Results: All the operations were successful. In the microscope group, the operative time was 168.0±33.1min, intraoperative bleeding volume was 125.0±40.2mL, total drainage volume was 379.6±220.6mL and postoperative length of stay was 5.2±1.3d, and dural tears occurred in 2 patients, none nerve injury or superficial wound infection was found. In the conventional group, the operative time was 155.8±29.4min, intraoperative bleeding volume was 133.9±59.7mL, total drainage volume was 452.2±464.5mL, and postoperative length of stay was 5.0±1.7d, and dural tears occurred in 4 patients, nerve injury was noticed in 1 patient, and none superficial wound infection was found. There was no statistical difference in perioperative and complication data between the two groups(P>0.05). Conclusions: Microscope does not increase the operative time, intraoperative bleeding volume, postoperative length of stay, and the rate of infection, dural tears and nerve injury in the revision surgery after PELD.