髂棘高度量化指标对L5、S1椎间盘突出经皮椎间孔镜入路影响的研究

目的寻找有效确定L5、S1椎间盘突出症患者行经皮椎间孔镜技术(percutaneous endoscopic lumbar discectomy,PELD)时影响穿刺、器械放置及镜下操作的量化指标。方法回顾性分析2014年5月—2016年3月100例术前拟行PELD治疗的单节段L5、S1椎间盘突出患者,其中66例(A组)成功行PELD手术,余34例(B组)因髂骨等周围骨性结构的影响导致穿刺、置管或镜下操作失败,改行其他手术方式。通过分析两组患者术前腰椎正位(包括双侧髂骨)X线片,创新性地提出髂高率及髂角率概念,测量并比较两组髂高率和髂角率,并采用ROC曲线分析确定髂高率、髂角率的诊断临界点。结果A、B组髂高率分别为0.61±0.09、0.74±0.05,髂角率分别为0.66±0.08、0.80±0.08,两组比较差异均有统计学意义(F=69.729,P=0.000;F=65.165,P=0.000)。ROC曲线分析示髂高率临界点为0.71(ROC曲线下面积0.927,P=0.000),髂角率临界点为0.75(ROC曲线下面积0.965,P=0.000)。结论对L5、S1椎间盘突出症患者,当髂高率>0.71和/或髂角率>0.75时,不宜直接采用PELD入路手术,宜采用经髂骨入路、椎板间入路或开放手术,以降低手术风险、减轻患者痛苦。

Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L5, S1 lumbar disc herniation

Objective To identify effect of quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy(PELD)treatment in patients with L5,S1 lumbar disc herniation.Methods A retrospective study between May 2014 and March 2016 was conducted,including 100 patients with disc herniation at L5,S1,who were initially enrolled for the PELD treatment.Among them,66 patients were successfully treated with PELD(group A),and the other 34 patients failed to perform puncture,catheterization,or microscopical operation due to the influence of iliac bone and other peripheral bone structures and treated with alternative surgical plans.By analyzing the X-ray films of lumbar vertebrae(including bilateral ilium)of the two groups before operation,the concept of ilium height rate and ilium angle rate was put forward innovatively.The ilium height rate and ilium angle rate of the two groups were measured and compared,and the diagnostic critical points of ilium height rate and ilium angle rate were determined by ROC curve analysis.Results The ilium height rate was 0.61±0.09,0.74±0.05 and the ilium angle rate was 0.66±0.08,0.80±0.08 in groups A and B,respectively,showing significant differences between the two groups(F=69.729,P=0.000;F=65.165,P=0.000).ROC curve analysis showed that the critical point of ilium height rate was 0.71(area under ROC curve was 0.927,P=0.000),and the critical point of ilium angle rate was 0.75(area under ROC curve was 0.965,P=0.000).Conclusion PELD is not recommended for patients with L5,S1 intervertebral disc herniation,when the ilium height rate is greater than 0.71 and/or the ilium angle rate is greater than 0.75.Other surgical plans such as transpedicular approach,transpedicular approach,or open surgery,should be recommended to reduce the risk of surgery and the pain of patients.