椎间孔镜靶向单通道髓核摘除术对腰椎融合术后相邻节段椎间盘突出症的临床运用分析

目的 探讨椎间孔镜靶向单通道髓核摘除术（TO-PTED）对腰椎融合术后相邻节段椎间盘突出症（LDH）的临床运用。方法 选取2018年1月—2021年3月在我院行TO-PTED术的45例腰椎融合术后相邻节段LDH患者为观察组，另随机选取同期在我院行椎板间开窗髓核摘除术的45例腰椎融合术后相邻节段LDH患者为对照组。比较两组患者的围手术期临床资料、手术前后的视觉模拟评分（VAS）、日本骨科协会评分（JOA）、影像学资料，采用改良MacNab标准来进行疗效的评价。结果 观察组患者的手术时长、术中失血量、住院天数均显著低于对照组，术中X线透视次数、临床优良率显著高于对照组（P＜0.05）。两组患者术后1个月、12个月的VAS评分显著低于术前，JOA评分显著高于术前（P＜0.05）。观察组患者术后1个月、12个月的VAS评分显著低于同期对照组，JOA评分显著高于同期对照组（P＜0.05）。术后1月观察组相对椎间高度及节段角度显著优于对照组，且术后12月，观察组相对椎间高度及节段角度维持优于对照组（P＜0.05）。两组术前、术后1月及12月相对椎间孔面积均无显著变化，且两组比较差异无统计学意义（P>0.05）。结论TO-PTED能明显缓解腰椎融合术后相邻节段LDH患者的疼痛状况，促进腰椎功能的恢复，具有创伤小、术中失血量少、术后恢复快等优点，疗效优于传统的椎板间开窗髓核摘除术，可在临床推广应用

Clinical application of targeted one-channel percutaneous transforaminal endoscopic discectomy in the treatment of adjacent segment lumbar disc herniation after spinal fusion surgery

Objective To investigate the efficacy of targeted one-channel percutaneous transforaminal endoscopic discectomy (TO-PTED) in the treatment of adjacent segment lumbar disc herniation (LDH) after spinal fusion surgery. Methods From January 2018 to March 2021, 45 patients with adjacent segment LDH after lumbar interbody fusion who underwent TO-PTED surgery in Baoding First Hospital of Traditional Chinese Medicine were selected as the observation group, and 45 patients with adjacent segment LDH after lumbar interbody fusion who underwent fenestration surgery of intervertebral disc nucleus pulposus in our hospital at the same time were randomly selected as the control group. The perioperative clinical data, preoperative and postoperative visual analog score (VAS), Japanese Orthopaedic Association (JOA) score and the modified Macnab standard were compared between the two groups. Results All operations were successfully completed. The operation time, intraoperative blood loss and hospital stay in the observation group were significantly lower than those in the control group, and the intraoperative X-ray fluoroscopy times and clinical excellent and good rate were significantly higher than those in the control group (P<0.05). For the intra-group comparison, the VAS score of the two groups at 1 month and 12 months after operation were significantly lower than the preoperative level, and the JOA score was significantly higher than the preoperative level (P<0.05). For the inter-group comparison, the VAS score of the observation group at 1 month and 12 months after operation were significantly lower than that of the control group at the same period, and the JOA score were significantly higher than that of the control group at the same period (P<0.05). The relative intervertebral height and segment angle in the observation group were significantly better than those in the control group one month after operation, and the relative intervertebral height and segment angle in the observation group were maintained better than those in the control group 12 months after operation (P<0.05). There was no significant difference in the relative intervertebral foramen area between the two groups before operation, 1 month and 12 months after operation, and the difference between the two groups was not statistically significant(P>0.05). Conclusion TO-PTED could significantly alleviate the pain of patients with adjacent segment LDH after spinal fusion surgery, and promote the recovery of lumbar function, which has the advantages of less trauma, less intraoperative bleeding, and rapid postoperative recovery. Its curative effect is better than that of traditional fenestration surgery of intervertebral disc nucleus pulposus and worthy of clinical application