摘要
目的 评价基于区域定位靶点穿刺的经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)治疗腰椎椎间盘突出症(LDH)对腰椎稳定性的影响。方法 2019年1月-2022年6月收治L4,5 LDH患者70例,30例采用基于区域定位靶点穿刺的PETD治疗(PETD组),40例采用后路椎板开窗椎间盘切除术治疗(对照组)。采用疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)及改良MacNab标准评估疗效。根据影像学和临床腰椎不稳标准综合评估腰椎不稳发生率。结果 所有手术均顺利完成,所有患者随访1年以上。2组术后各随访时间点VAS评分、ODI较术前明显改善,且PETD组优于对照组,差异均有统计学意义(P <0.05)。术后1年采用改良MacNab标准评定疗效,PETD组优28例、良1例、可1例,优良率为96.67%;对照组优30例、良4例、可5例、差1例,优良率为85.00%。结合影像学和临床腰椎不稳标准,PETD组腰椎不稳发生率为3.33%(1例),对照组为10.00%(4例)。结论 采用基于区域定位靶点穿刺的PETD治疗LDH疗效显著,对脊柱的生物力学结构破坏小,能够最大程度维持脊柱的稳定性。
Objective To evaluate the effect of percutaneous endoscopic transforaminal discectomy(PETD) based on regional localization targeted puncture for lumbar disc herriation(LDH)on lumbar stability.Methods From January 2019 to June 2022,70 patients with L4,s LDH were admitted.Among them,30 patients were treated with PETD based on regional localization targeted puncture(PETD group),while 40 were treated with fenestration discectomy(control group).The pain visual analog scale(VAS)score,Oswestry disability index(ODI)and modified MacNab criteria were used to evaluate the efficacy.The incidence of lumbar instability was comprehensively evaluated based on imaging and clinical criteria for lumbar instability.Results All the surgeries were successfully completed,and all the patients were followed up for more than 1 year.The VAS score and ODI at each follow-up time point after surgery were significantly improved in both groups,and the PETD group was better than the control group,with a statistically significant difference(P<0.05).At postoperative 1 year,the modified MacNab criteria was used to evaluate the therapeutic effect.In the PETD group,excellent in 28 cases,good in 1 and fair in 1,with an excellent and good rate of 96.67%;in the control group,excellent in 30 cases,good in 4,fair in 5 and poor in1,with an excellent and good rate of85.00%.Combining imaging and clinical criteria forlumbar instability,the incidenceof lumbar instability was 3.33%(1 case)in the PETD group,10.00%(4 cases)in the control group.Conclusion PETD based on regional localization targeted puncture for treatment of LDH has a significant therapeutic effect,with minimal damage to the biomechanical structure of the spine,and can maintain the stability of the spine to the maximum extent.
作者
张赫
王硕
高晓
彭伟
刘百峰
Zhang He;Wang Shuo;Gao Xiao;Peng Wei;Liu Baifeng(Department of Orthopaedics,Fifth AfiliatedHospitalof Harbin Medical University,Daqing 163000,Heilongjiang,China)
出处
《脊柱外科杂志》
2024年第2期94-99,共6页
Journal of Spinal Surgery
基金
2023年黑龙江省卫生健康委科研课题项目
大庆市指导性科技计划项目(zdy-2023-52)
哈尔滨医科大学附属第五医院科研基金(2023-006)。
关键词
腰椎
椎间盘移位
内窥镜检查
外科手术
微创性
Lumbar vertebrae
Intervertebral disc displacement
Endoscopy
Surgical procedures,minimally invasive
