侧卧位与俯卧位椎板间入路椎间孔镜治疗单纯L5/S1椎间盘突出症的对比研究

Comparative study of treatment of simple L5/S1 disc herniation with interlaminar approach in lateral decubitus position and prone position

摘要:

目的 对比侧卧位（LDP）与俯卧位（PP）椎板间入路椎间孔镜治疗单纯L₅/S₁椎间盘突出症（LDH）的有效性及安全性。方法 回顾性分析2017年1月－2018年1月该院51例行椎间孔镜手术治疗的单纯L₅/S₁ LDH患者的临床资料。根据术中体位不同分为LDP组和PP组。LDP组（n = 20）男12例，女8例，年龄33～78岁，平均（54.33±9.13）岁；PP组（n = 31）男18例，女13例，年龄30～68岁，平均（52.31±6.54）岁。记录术中两组患者手术时间、术中透视次数、术中因体位所致不适感、颈痛发生率等情况，通过Likert评分评价患者术中不适感，比较两组患者手术前后腰腿痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分，最终依据改良MacNab标准评估末次随访的疗效。结果 LDP组手术时间40～100 min，平均（61.59±14.27） min；透视次数2～6次，平均（3.32±0.22）次，Likert评分（3.93±0.73）分，术中仅1例发生轻微颈痛症状；PP组手术时间45～90 min，平均（60.38±15.42） min；透视次数2～4次，平均（3.23±0.14）次，Likert评分（3.49±0.65）分，5例出现颈痛症状；两组患者手术时间和透视次数比较，差异均无统计学意义（P > 0.05）。两组患者术后腰腿痛VAS和ODI评分与术前比较，差异均有统计学意义（P < 0.05）；两组患者间腰腿痛VAS、ODI评分和末次MacNab评分比较，差异均无统计学意义（P > 0.05）。LDP组术中Likert评分较PP组高，且颈痛发生率低（P < 0.05）；PP组术后1例患者出现足跖屈肌麻痹，予保守治疗后肌力恢复至4级；两组患者均未发生脑脊液漏、节段错误和椎间隙感染等并发症。结论 LDP与PP椎板间入路椎间孔镜治疗单纯L₅/S₁ LDH均可获得良好疗效，但前者舒适性高，患者更易配合和接受，可在临床推广应用。

Abstract:

Objective To compare the efficacy and safety of percutaneous endoscopic interlaminar discectomy by the lateral decubitus position (LDP) and prone position (PP) in treatment of simple L₅/S₁ disc herniation (LDH).Methods Clinical data of 51 patients with simple L₅/S₁ LDH underwent percutaneous endoscopic interlaminar discectomy from January 2017 to January 2018 were retrospectively analyzed. They were divided into LDP group and PP group according to different intraoperative position. LDP group (n = 20) had 12 males and 8 females, the average age was (54.33 ± 9.13) years from 33 to 78 years; PP group (n = 31) had 18 males and 13 females, the average age was (52.31 ± 6.54) years from 30 to 68 years. The operative time, the times of intraoperative fluoroscopy, the discomfort caused by body position and the incidence of neck pain were recorded. The intraoperative discomfort was evaluated by Likert score, and the VAS and ODI scores of lumbar and legs pain before and after the operation were compared between the two groups. Finally, the efficacy of the last follow-up was evaluated according to the modified MacNab.Results In LDP group, the operation time was 40 ~ 100 min, with an average of (61.59 ± 14.27) min, the average number of fluoroscopy was 2 ~ 6 times, with an average of (3.32 ± 0.22) times, and the Likert score was (3.93 ± 0.73), only one patient had mild neck pain during the whole operation. In the PP group, the operation time was 45 ~ 90 min, with an average of (60.38 ± 15.42) min, the number of fluoroscopy was 2~4 times, with an average of (3.23 ± 0.14) times, the Likert score was (3.49 ± 0.65), 5 patients suffered neck pain. There were no significant difference in the time of operation and the times of fluoroscopy between the two groups (P > 0.05). The VAS and ODI scores of the two groups after surgery were significantly different from those before surgery (P < 0.05); There were no significant differences in VAS, ODI scores and last MacNAB scores between the two groups (P > 0.05). The Likert score in the LDP group was higher than that in the PP group, and the incidence of neck pain was lower than that in the PP group (P < 0.05). One patient in the PP group developed plantar flexor paralysis, and the muscle strength recovered to level 4 after conservative treatment. There were no complications such as cerebrospinal fluid leakage, segmental errors, and intervertebral space infection.Conclusion Both LDP and PP percutaneous endoscopic interlaminar discectomy in treatment of simple L₅/S₁ LDH, but the former has high comfort and easier to cooperate and be accepted, it can be popularized and applied in clinic.