椎间孔镜术治疗复发性腰椎间盘突出

[目的]探讨椎间孔镜在腰椎间盘突出症经椎板间隙开窗髓核摘除术后复发治疗中的临床效果。[方法]2015年7月~2018年10月收治的68位经椎板开窗髓核摘除术后复发的腰椎间盘突出症患者纳入本研究,采用随机数字表法将患者分为两组,经椎间孔镜椎间盘切除术(PTED)组34例,行椎间孔镜辅助下髓核摘除、神经根减压术;改良后路椎体间融合术(PLIF)组34例,行改良PLIF技术髓核摘除、神经根减压、椎间融合内固定术。比较两组临床、实验室和影像资料。[结果]两组患者均顺利手术,均无严重并发症。PTED组在手术时间、切口大小、术中出血量、术后卧床天数和住院天数方面显著优于PLIF组(P<0.05)。但是,PTED组的透视次数及放射暴露量显著大于PLIF组(P<0.05)。两组患者随访12~18个月,随时间推移,两组患者的VAS和ODI评分均显著下降(P<0.05)。术后3周时PTED组的VAS评分显著低于PLIF组(P<0.05),而术后6~12个月两组间VAS评分差异无统计学意义(P>0.05);术后3周~6个月时,PTED组ODI显著小于PLIF组(P<0.05),术后12个月时,两组间ODI评分的差异无统计学意义(P>0.05)。实验室检验方面,术后3 d,PTED组的CPR和CK显著低于PLIF组(P<0.05)。影像方面,末次随访时PTED组34例患者动力位X线片未见节段失稳改变,邻近节段无退变加重;PLIF组34例均达到骨性愈合,无内固定松动。[结论]椎间孔镜在治疗腰椎间盘突出症经椎板开窗髓核摘除术后复发患者中,具有创伤小、近期恢复快、对脊柱稳定性影响小的优点,但有放射暴露量大的缺陷。

Percutaneous transforaminal endoscopic discectomy for recurrent disc herniation secondary to open laminectomy and discectomy

[Objective] To explore the advantages and disadvantages of percutaneous transforaminal endoscopic discectomy(PTED) for recurrent lumbar disc herniation secondary to open laminectomy and discectomy. [Methods]From July 2015 to October 2018, 68 patients who suffered from recurrent lumbar disc herniation secondary to open laminectomy and discectomy were enrolled into this study, and divided into two groups by random number table method. Of them, 34 patients received PTED,while the remaining 34 patient underwent the modified posterior lumbar interbody fusion(PLIF). The documentations, including clinical, laboratory test and image data were compared between the two group. [Results] All the patients in both group had surgical procedures performed smoothly without serious complications. The PTED group proved significantly superior to the PLIF group regarding operation time, incision length, intraoperative blood loss, bed rest time and hospital stay(P<0.05), nevertheless the PTED group got significantly more fluoroscopy frequency, and greater radiation exposure than the PLIF group(P<0.05). The follow-up period lasted for 12~18 months. As time went both VAS and ODI scores in both groups significantly decreased(P<0.05). The PTED group had significantly lower VAS score than the PLIF group at 3 weeks after operation(P<0.05),which became statistically insignificant between the two groups from 6 months to 12 months postoperatively(P>0.05). In addition, the PTED group had significantly lower ODI scores than the PLIF group at 3 weeks, 3 months and 6 months after operation(P<0.05), which turned to be not statistically significant at 12 months postoperatively(P>0.05). Regarding to laboratory tests,the PTED group had significantly lower CRP and CK at 3 days afer operation than the PLIF group(P<0.05). In term of radiographic assessment, no remarkable instability of the involved segment, and no prominent worsening of adjacent segment degeneration was found in any patient of the PTED group at the latest follow up. On the other hand, bony fusion of involved segment achieved in all patients of the PLIF group without implant loosening. [Conclusion] The PTED achieves satisfactory clinical outcomes similar to the PLIF for recurrent disc herniation, and has benefits of minimal trauma, earlier recovery and less impact on spinal stability, whereas disadvantage of greater radiation exposure.