经皮内窥镜下腰椎椎间盘切除术治疗双节段腰椎椎间盘突出症的临床疗效与安全性

目的 评估经皮内窥镜下腰椎椎间盘切除术（PELD）治疗双节段腰椎椎间盘突出症（LDH）的临床疗效与安全性。方法 2017年8月—2022年3月，海军军医大学长征医院采用PELD治疗双节段LDH患者40例（双节段组），并按照年龄、性别和手术节段匹配同期采用PELD治疗的单节段LDH患者80例（单节段组）。比较2组手术时间、术中透视次数、住院时间、并发症发生情况、疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）及临床疗效。结果 双节段组手术时间和术中透视次数高于单节段组，差异均有统计学意义（P <0.05）;2组术后各随访时间点VAS评分、ODI较术前明显改善，差异均有统计学意义（P <0.05）；组间差异无统计学意义（P> 0.05）。根据改良MacNab标准，双节段组和单节段组末次随访时疗效优良率分别为87.5%和85.0%。2组并发症发生率、复发率、再手术率差异均无统计学意义（P> 0.05）。2组均无腰椎不稳、术中神经根损伤或术后血肿/感染等并发症发生。结论 PELD治疗双节段LDH疗效确切，且不会影响术后脊柱稳定性或增加术后复发风险。

Clinical efficacy and safety of percutaneous endoscopic lumbar discectomy for treatment of dual-segment lumbar disc herniation

Objective To evaluate the clinical efficacy and safety of percutaneous endoscopic lumbar discectomy（PELD） for the treatment of dual-segment lumbar disc herniation（LDH）. Methods From August 2017 to March 2022，40 patients with dual-segment LDH（dual-segment group） were treated with PELD at the Changzheng Hospital affiliated to Naval Medical University，and 80 patients with single-segment LDH（single-segment group） were treated with PELD at the same time according to age，gender，and surgical segment matching. The operation time，intraoperative fluoroscopy frequency，hospital stay，incidence of complications，the pain visual analog scale（VAS） score and Oswestry disability index（ODI） and efficacy of the 2 groups were compared. Results The operation time and intraoperative fluoroscopy frequency in the dual-segment group were higher than those in the single-segment group，and the differences were statistically significant（P ＜ 0.05）. The VAS score and ODI at each follow-up time point of post-operation were significantly improved in both groups，with a statistically significant difference（P ＜ 0.05）；and there was no statistically significant difference between the 2 groups（P ＞ 0.05）. According to the modified MacNab criteria，the excellent and good efficacy rates for the dual-segment group and single segment group were 87.5% and 85.0%，respectively. There was no statistically significant difference in the incidence of complications，recurrence rate and reoperation rate between the 2 groups（P ＞ 0.05）. Both groups had no complications such as lumbar instability，intraoperative nerve root injury or postoperative hematoma/infection. Conclusion PELD for the treatment of dual-segment LDH is effective，and does not affect postoperative spinal stability or increase the risk of postoperative recurrence.