经Kambin三角顶点入路椎间孔镜手术治疗髓核高度上游离椎间盘突出症的临床价值

目的探讨经Kambin三角顶点入路椎间孔镜手术在髓核高度上游离椎间盘突出症中的应用价值。方法回顾性分析76例髓核高度上游离椎间盘突出症患者的临床资料,其中经Kambin三角顶点入路椎间孔镜手术治疗的38例患者纳入观察组;基线资料与观察组匹配,且经椎板间入路椎间孔镜手术治疗的38例患者作为对照组。比较两组的手术出血量、切口长度、手术时间、术后卧床时间、住院时间,以及手术前后腰痛和下肢疼痛的VAS评分。结果两组手术出血量、手术时间、术后卧床时间及住院时间比较,差异均无统计学意义(均P>0.05);观察组的切口长度短于对照组(P<0.05)。术前、术后24 h及术后1年两组腰痛和下肢疼痛的VAS评分差异均无统计学意义(均P>0.05),但两组术后24 h、术后1年腰痛VAS评分及下肢疼痛的VAS评分均显著低于术前(均P<0.05)。结论经Kambin三角顶点和经椎板间两种入路的椎间孔镜手术治疗髓核高度上游离椎间盘突出症疗效显著。临床上可结合患者的实际情况选择个性化治疗方案。

Clinical value of transforaminal endoscopic surgery via the top point approach of Kambin triangle in treating lumbar disc herniation for high-grade up-migrated nucleoid

Objective To investigate the application value of transforaminal endoscopic surgery via the top point approach of Kambin triangle in the lumbar disc herniation for high-grade up-migrated nucleoid.Methods The clinical data of 76 patients with lumbar disc herniation for high-grade up-migrated nucleoid were retrospectively analyzed,among which 38 patients underwent transforaminal endoscopic surgery via the top point approach of Kambin triangle were enrolled in observation group,whereas 38 patients,whose baseline data matched with the observation group,undergoing transforaminal endoscopic surgery via interlaminar approach were enrolled in control group.The intraoperative blood loss volume,incision length,surgery duration,postoperative in-bed time,hospital stays,and VAS scores of lumbago and lower limb pain before and after surgery were compared between the two groups.Results There were no statistically significant differences in intraoperative blood loss volume,surgery duration,postoperative in-bed time,and hospital stays between the two groups(all P>0.05).The incision length of the observation group was shorter than that of the control group(P<0.05).There were no statistically significant differences in the VAS scores of lumbago and lower limb pain before surgery,24 h and 1 year after surgery between the two groups(all P>0.05);however,the scores mentioned above in the two groups were significantly lower after 24 h and 1 year of surgery than before surgery(all P<0.05).Conclusion Transforaminal endoscopic surgery via the top point approach of Kambin triangle and via interlaminar approach in the treatment of lumbar disc herniation for high-grade up-migrated nucleoid has a prominent efficacy.Individualized treatment scheme can be selected according to the actual situation of patients in the clinic.