经椎间孔入路经皮内窥镜下腰椎椎间盘切除术治疗高原地区高/低位腰椎椎间盘突出症

目的探讨经椎间孔入路经皮内窥镜下腰椎椎间盘切除术(PETD)治疗高原地区高/低位腰椎椎间盘突出症(LDH)的临床疗效。方法2018年3月—2020年3月,本院收治高原地区LDH患者88例,按椎间盘突出节段分为高位组(L1~4,A组,42例)和低位组(L4~S1,B组,46例),均采用PETD治疗。记录并比较2组患者手术时间、术中出血量、住院时间,术前和术后3个月疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI),术前和术后3周空腹状态下静脉血炎性因子水平。采用MacNab标准评价手术疗效。结果所有手术顺利完成,所有患者随访6个月。A组术前股神经牵拉试验阳性率、感觉障碍发生率、腰痛VAS评分及炎性因子水平显著高于B组,差异均有统计学意义(P<0.05)。A组术后住院时间显著长于B组,差异有统计学意义(P<0.05)。术后3个月,2组VAS评分、JOA评分、ODI及炎性因子水平均较术前显著改善,差异均有统计学意义(P<0.05);组间比较,差异均无统计学意义(P>0.05)。2组疗效优良率差异无统计学意义(P>0.05)。2组均未发生硬膜撕裂、深静脉血栓、感染、马尾神经损伤等并发症,并发症发生率差异无统计学意义(P>0.05)。结论PETD治疗高原地区高/低位LDH总体疗效相当;高位LDH患者术前腰痛症状较低位患者更重,股神经牵拉试验多呈阳性,住院时间更长。

Percutaneous endoscopic transforaminal discectomy for high/low level lumbar disc herniation at plateau area

Objective To investigate the clinical efficacy of percutaneous endoscopic transforaminal discectomy(PETD) for the treatment of high/low level lumbar disc herniation(LDH) in the plateau areas. Methods From March 2018 to March 2020,88 patients with LDH in the plateau area were treated in our hospital. They were divided into high level group(L_1-4,group A,42 cases) and low level group(L₄-S₁,group B,46 cases) according to the herniation segment. All the patients were treated with PETD. The operation time,intraoperative blood loss,hospital stay,visual analogue scale(VAS) score,Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) at pre-operation and postoperative 3 months,the inflammatory factor levels in the venous blood at pre-operation and postoperative 3 weeks were recorded and compared. The MacNab criteria was used to evaluate the effect of operation. Results All the operations were successfully completed. The patients were followed up for 6 months. The positity rate of femoral nerve stretch test,incidence of sensory disturbance,VAS score of low back pain and inflammatory factors in group A were significantly higher than those in group B,all with a statistical significance(P<0.05). The postoperative hospital stay in group A was significantly longer than that in group B,with a statistical significance(P<0.05). At postoperative 3 months,the VAS score,JOA score,ODI and inflammatory factor levels of the 2 groups were significantly improved compared with those at pre-operation,all with a statistical significance(P<0.05),but there was no significant difference between the 2 groups(P>0.05). There was no significant difference in the excellent and good rate of efficacy between the 2 groups(P>0.05). There was no complication such as dural tear,deep vein thrombosis,infection and cauda equina nerve injury in the 2 groups,and there was no significant difference in the incidence of complication between them(P>0.05). Conclusions The overall effect of PETD in the treatment of high/low level LDH in the plateau area is similar. The symptoms of low back pain in the patients with high level LDH are more serious than those in the patients with low level LDH,and the femoral nerve stretch test is mostly positive and the hospital stay is longer in the patients with high level LDH.