脊柱内镜手术联合富血小板血浆治疗极外侧型腰椎间盘突出症的临床疗效

Efficacy of spinal endoscopic surgery combined with platelet-rich plasma in the treatment of far lateral lumbar disc herniation

中文关键词:  极外侧型腰椎间盘突出症  脊柱内镜  富血小板血浆  神经病理性疼痛

英文关键词:Far lateral lumber disc herniation  Spinal endoscopy  Platelet-rich plasma(PRP)  Neuropathic pain

中文摘要:

  【摘要】 目的：评估单通道脊柱内镜下侧路经椎间孔腰椎间盘切除术（transforaminal endoscopic lumbar discectomy，TELD）联合自体富血小板血浆（platelet-rich plasma，PRP）治疗极外侧型腰椎间盘突出症（far lateral lumbar disc herniation，FLLDH）的早中期疗效。方法：回顾性分析2020年5月～2024年12月于本院脊柱外科行TELD治疗的74例FLLDH患者，其中32例接受TELD，并于减压完成后在出口神经根周围注射自体PRP（PRP组），男13例，女19例，平均年龄65.96±14.05岁；42例仅行TELD（对照组），男11例，女31例，平均年龄58.84±16.15岁。使用倾向性评分匹配法（propensity score matching，PSM）以年龄、性别、BMI、病程为协变量进行1∶1匹配，最终每组各24例纳入研究。比较两组患者术前、术后3d、1周、6周、3个月、6个月的腰腿部疼痛视觉模拟评分（visual analog scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI）；术后3个月通过腰椎动力位X线片检查评估稳定性；术后6个月采用改良MacNab标准评价疗效。结果：两组患者术后各时间点腰腿部VAS评分及ODI均较术前显著改善（P<0.05）。术后3d、1周及6周，PRP组腰腿部VAS评分及ODI均显著低于对照组，两组差异有统计学意义（P<0.05）；术后3个月及6个月，两组间差异无统计学意义（P>0.05）。术后3个月腰椎动力位X线片显示，两组腰椎稳定性与术前相比均无变化，组间差异无统计学意义（P>0.05）。术后6个月改良MacNab标准评定，PRP组优良率为87.5%，对照组优良率为83.3%，组间差异无统计学意义（P>0.05）。结论：TELD是治疗FLLDH安全有效的手术方式。TELD联合PRP可加速FLLDH患者术后早期（≤6周）神经根疼痛及功能的恢复，效果优于单纯TELD；但中期（3～6个月）疗效相当。

英文摘要:

  【Abstract】 Objectives: To evaluate the early-to-midterm clinical outcomes of single-portal transforaminal endoscopic lumbar discectomy(TELD) combined with platelet-rich plasma(PRP) in the treatment of far lateral lumbar disc herniation(FLLDH). Methods: A retrospective analysis was conducted on 74 FLLDH patients who underwent TELD at the Department of Spinal Surgery, between May 2020 and December 2024. Among them, 32 patients underwent TELD followed by an injection of autologous PRP around the exiting nerve root upon completion of decompression(PRP group), which consisted of 13 male cases and 19 female cases, with an average age of 65.96±14.05 years; while 42 patients received TELD alone(control group), and there were 11 male cases and 31 female cases, with an average age of 58.84±16.15 years. Propensity score matching(PSM) was performed using four covariates(gender, age, BMI, disease duration) in a 1∶1 ratio, resulting in 24 matched patients per group. Outcomes assessed preoperatively and at 3d, 1 week, 6 weeks, 3 months, and 6 months postoperatively included visual analog scale(VAS) scores for low back and leg pain and Oswestry disability index(ODI). Lumbar stability was evaluated using flexion-extension X-rays at the 3-month follow-up. Treatment efficacy was rated using the modified MacNab criteria at the 6-month follow-up. Results: Both groups showed significant improvement in VAS scores and ODI compared to preoperative baselines(P<0.05). The PRP group exhibited significantly lower VAS scores and ODI indices than the control group at postoperative 3d, 1 week, and 6 weeks, with a statistically significant difference between groups(P<0.05). However, no significant differences were observed between the two groups at postoperative 3 months or 6 months(P>0.05). Lumbar stability assessed by flexion-extension X-rays at 3 months remained unchanged compared to preoperative status, with no significant difference between groups(P>0.05). At 6 months, the excellent and good rates according to the modified MacNab criteria were 87.5% in the PRP group and 83.3% in the control group, with no statistically significant difference between groups(P>0.05). Conclusions: TELD is a safe and effective surgical approach for the treatment of FLLDH. Comparing to TELD alone, TELD combined with PRP can promote faster recoveries from radicular pain and functional impairment in patients with FLLDH in the early postoperative period(≤6 weeks), while the efficacy is comparable to TELD alone in the mid-term(3-6 months).