可视化工作通道辅助经皮椎间孔镜手术治疗腰椎间盘突出症的临床效果

Clinical efficacy of visual working channel assisted percutaneous transforaminal endoscopic discectomy in treating lumbar disc herniation

中文关键词:  腰椎间盘突出症  经皮椎间孔镜椎间盘切除术  可视工作通道  微创

英文关键词:Lumbar disc herniation  Percutaneous transforaminal endoscopic discectomy  Visual working channel  Minimally invasive

中文摘要:

  【摘要】目的：探讨可视化工作通道辅助经皮椎间孔镜椎间盘切除术（percutaneous transforaminal endoscopic discectomy，PTED）治疗腰椎间盘突出症的临床效果。方法：回顾性分析2022年6月~2023年6月接受PTED治疗腰椎间盘突出症的141例患者的病历资料，按照可视化工作通道的使用情况分为可视组68例（男性38例，女性30例，年龄48.0±15.9岁），在PTED中应用透明可视化工作通道；传统组73例（男性46例，女性27例，年龄47.6±16.9岁），在PTED中应用传统金属工作通道。两组患者的一般资料（性别、年龄等）比较，差异无统计学意义（P>0.05）。比较两组患者手术时间、术中出血量、术后住院时间及并发症发生情况。采用疼痛视觉模拟量表（visual analogue scale，VAS）评分评估患者腰腿痛的程度，采用Oswestry功能障碍指数（Oswestry disability index，ODI）评估患者腰椎功能，分别记录术前，术后1周，术后1、3、6个月以及末次随访时的腰腿痛VAS评分及ODI情况；末次随访时采用MacNab标准评估手术患者的临床疗效。结果：可视组的手术时间、术中出血量、术后住院时间均少于传统组（71.06±8.97min vs 75.16±9.47min，14.19±2.66mL vs 15.58±2.81mL，2.16±0.96d vs 2.54±1.23d），差异有统计学意义（P<0.05）。两组术后1周，术后1、3、6个月及末次随访时的VAS评分、ODI较两组术前均有明显改善（P<0.05）。可视组末次随访时的VAS评分和ODI较传统组均有所改善[1.18±0.39分 vs 1.27±0.45分，（3.97±1.67）% vs （4.54±1.55）%]，差异有统计学意义（P<0.05）。末次随访时按MacNab标准，可视组优53例、良12例、可3例，优良率为95.6%；传统组优52例、良15例、可4例、差2例，优良率为91.8%。两组优良率差异无统计学意义（P>0.05）。可视组无手术相关并发症发生，传统组术后发生4例神经激惹征，2例术后发生复发；传统组并发症发生率为8.2%，可视组并发症发生率小于传统组，差异有统计学意义（P<0.05）。结论：可视化工作通道辅助PTED治疗腰椎间盘突出症，具有手术时间短、术中出血少、术后康复快以及并发症发生少等优点。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of visual working channel assisted percutaneous transforaminal endoscopic discectomy(PTED) in treating lumbar disc herniation(LDH). Methods: The medical records of 141 LDH patients who underwent PTED between June 2022 and June 2023 were retrospectively analyzed. The patients were divided into two groups of the visual group consisting of 68 cases(38 males and 30 females, with an average age of 48.0±15.9 years), and the transparent visual working channel was applied in PTED; And the traditional group including 73 cases(46 males and 27 females, with an age of 47.6±16.9 years), and the traditional metal working channel was applied in PTED. There was no statistical difference in the general data(gender, age, etc) between the two groups(P>0.05). The operative time, intraoperative blood loss, postoperative length of hospital stay, and complication occurrence were compared between the two groups. The degree of low back pain was assessed using the visual analogue scale(VAS) score for pain, and the lumbar spine function was assessed using the Oswestry disability index(ODI) before operation, at one week and, 1, 3, and 6 months after surgery, and final follow-up, respectively. The MacNab criteria were used to assess the clinical outcomes of patients at the final follow-up. Results: The operative time, intraoperative blood loss, and postoperative length of hospital stay in the visual group was all less than those in the traditional group(71.06±8.97min vs 75.16±9.47min, 14.19±2.66mL vs 15.58±2.81mL, 2.16±0.96d vs 2.54±1.23d), and the differences were statistically significant(P<0.05). The VAS scores and ODI one week after surgery, 1, 3, and 6 months after surgery, and at the final follow-up were significantly improved compared with the preoperative values in both groups(P<0.05). At the final follow-up, the VAS score and ODI in the visual group were significantly improved compared with those in the traditional group[1.18±0.39 vs 1.27±0.45, (3.97±1.67)% vs (4.54±1.55)%], and the differences were statistically significant(P<0.05). According to the MacNab criteria at the final follow-up, 53 cases in the visual group were excellent, 12 cases were good, and 3 cases were possible, with an excellent and good rate of 95.6%; 52 cases in the traditional group were excellent, 15 cases were good, 4 cases were possible, and 2 cases were poor, with an excellent and good rate of 91.8%(P>0.05). No surgery-related complications occurred in the visual group and 4 cases of nerve root irritation signs and 2 cases of postoperative recurrence occurred in the traditional group; The complication rate of the traditional group was 8.2%, and the complication rate of the visual group was lower than that of the traditional group, and the difference was statistically significant(P<0.05). Conclusions: The visual working channel assisted PTED has the advantages of short operative time, little intraoperative bleeding, fast postoperative recovery, and few complications in treating LDH.