中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (21): 3344-3348.doi: 10.12307/2024.083

• 骨科植入物 orthopedic implant • 上一篇    下一篇

可视化环锯成形治疗单节段腰椎间盘突出症的1年随访

陈  风1，2，李东亚2，潘  彬2，袁海波1，2，吴继彬2   

  1. 1徐州医科大学，江苏省徐州市   221000；2徐州医科大学附属医院骨科，江苏省徐州市   221000
  • 收稿日期:2023-04-24 接受日期:2023-06-15 出版日期:2024-07-28 发布日期:2023-09-27
  • 通讯作者: 吴继彬，博士，主任医师，徐州医科大学附属医院骨科，江苏省徐州市 221000
  • 作者简介:陈风，男，1990年生，安徽省宿州市人，汉族，徐州医科大学在读硕士，医师，主要从事脊柱外科相关研究。
  • 基金资助:
    徐州市2021年推动科技创新专项资金(KC21177)，项目负责人：潘彬

One-year follow-up of visual trephine arthroplasty for single-level lumbar disc herniation

Chen Feng1, 2, Li Dongya2, Pan Bin2, Yuan Haibo1, 2, Wu Jibin2   

  1. 1Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China; 2Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Received:2023-04-24 Accepted:2023-06-15 Online:2024-07-28 Published:2023-09-27
  • Contact: Wu Jibin, MD, Chief physician, Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • About author:Chen Feng, Master candidate, Physician, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China; Department of Orthopedics, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Supported by:
    2021 Special Fund to Promote Scientific and Technological Innovation of Xuzhou, No. KC21177 (to PB)

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摘要：


文题释义：

经皮内镜下可视化环锯成形术：根据手术入路不同可分为经椎间孔入路和经椎板间入路，经椎间孔入路可根据需要通过环锯去除部分上关节突肩部、椎弓根，经椎板间入路则通过对“V”点的成形，来扩大手术操作空间，达到减压目的。
腰椎间盘突出症：是临床最常见的脊柱退行性疾病，也是引起腰背痛的常见原因，其病程长、易复发，有长期的腰背部及下肢麻木、刺痛，严重影响患者的生活质量、严重者甚至会造成患者残疾。


背景：随着脊柱微创手术的进步，脊柱内镜下腰椎减压已广泛应用于腰椎间盘突出症患者的治疗，不同内窥镜手术入路的适应证不同，具体手术方案的决策需要结合实际情况和临床手术医师的选择。

目的：探讨经皮内镜下可视化环锯成形治疗单节段腰椎间盘突出症的近期疗效。 
方法：纳入2019年1月至2021年12月徐州医科大学附属医院收治的符合纳入标准的单节段腰椎间盘突出症患者90例，根据经皮内镜下可视化环锯成形的不同入路分为经椎间孔入路组(对照组，n=48)和经椎板间入路组(试验组，n=42)，记录两组患者一般情况，包括性别、年龄、病程、体质量指数、切口长度、手术耗时、术中透视次数、住院天数、出血量，评估不同随访阶段的疼痛目测类比评分、日本骨科协会评分，采用改良 MacNab 标准评估末次随访时的临床效果，并统计术后并发症及复发率情况。 

结果与结论：①试验组手术耗时及术中透视次数较对照组少，差异有显著性意义(P < 0.05)；但两组在术中出血量、切口长度、住院天数的差异无显著性意义(P > 0.05)；②两组术前目测类比评分及日本骨科协会评分的差异无显著性意义(P > 0.05)，术后1周及3，6，12个月的目测类比评分及日本骨科协会评分与术前相比均显著改善(P < 0.05)；③末次随访的改良 MacNab 标准优良率，对照组为94%，试验组为95%；④对照组有1例患者术后仍感腰腿痛，行开放性手术，术后恢复良好，无明显后遗症状；而试验组术后未出现并发症及复发病例；⑤提示经皮椎间孔入路及椎板间入路内镜下可视化环锯成形治疗单节段腰椎间盘突出症都具有良好的短期临床疗效和较高的患者满意度，但经椎板间入路手术耗时更短、术中透视次数更少。

https://orcid.org/0000-000-4963-7991 (陈风) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 腰椎间盘突出症, 环锯成形术, 经皮椎间孔内镜, 经皮椎间孔入路, 经皮椎板间入路

Abstract: BACKGROUND: With the progress of minimally invasive procedures of the spine, endoscopic lumbar decompression has been widely used in the treatment of lumbar disc herniation. The indications of different endoscopic surgical approaches are different, and the decision of the specific operation plan needs to be combined with the actual situation and the choice of clinical surgeons.
OBJECTIVE: To investigate the short-term effect in treatment of single-level lumbar disc herniation by percutaneous endoscopic visual trephine arthroplasty.
METHODS: Ninety patients with single-level lumbar disc herniation admitted to Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021 who met the inclusion criteria were included in this study. According to different approaches of percutaneous endoscopic visual trephine arthroplasty, they were divided into transforaminal approach group (control group, n=48 cases) and translaminar approach group (trial group, n=42 cases). The general information of patients in the two groups was recorded, including sex, age, disease course, body mass index, incision length, operation time, intraoperative fluoroscopy times, length of hospital stay, and amount of blood loss. Visual analog scale score of pain and Japanese Orthopaedic Association score at different follow-up stages were assessed. The modified MacNab standard was used to evaluate the clinical outcome at the last follow-up, and the postoperative complications and recurrence rate were measured.
RESULTS AND CONCLUSION: (1) The operation time and intraoperative fluoroscopy times of the trial group were less than those of the control group, and the difference was statistically significant (P < 0.05). However, there were no significant differences in intraoperative blood loss, incision length, and hospital stay between the two groups (P > 0.05). (2) There was no significant difference in visual analog scale score of pain and Japanese Orthopaedic Association score between the two groups before surgery (P > 0.05). However, visual analog scale of pain and Japanese Orthopaedic Association score were significantly improved 1 week, 3, 6, and 12 months after surgery (P < 0.05). (3) At the last follow-up, the good and good rate of modified MacNab standard was 94% in the control group and 95% in the trial group. (4) In the control group, one patient still felt back and leg pain after surgery, underwent open surgery, and recovered well after surgery without obvious sequelae. There were no postoperative complications or recurrent cases in the trial group. (5) It is concluded that both percutaneous transforaminal approach and interlaminar approach have good short-term clinical efficacy and high patient satisfaction in the treatment of single-level lumbar disc herniation, but the time of the interlaminar approach is shorter and has less intraoperative fluoroscopy times.

Key words: lumbar disc herniation, trephine arthroplasty, percutaneous transforaminal endoscopy, percutaneous transforaminal approach, percutaneous interlaminar approach

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