Delta内镜下腰椎减压融合术治疗巨大型腰椎间盘突出症的疗效

Clinical effect of Delta endoscopic lumbar decompression fusion for giant lumbar disc herniation

摘要:

目的 探讨Delta内镜下腰椎减压融合术治疗巨大型腰椎间盘突出症（GILDH）的临床疗效。方法 选择2020年4月－2022年5月该院36例GILDH患者作为研究对象。其中，DELTA组18例，开放组18例。两组患者性别、年龄和责任节段比较，差异均无统计学意义。比较两组患者手术时间、围手术期指标和临床疗效。结果 Delta组术中出血量和术后引流量少于开放组，切口长度和住院时间短于开放组，椎旁肌损伤程度轻于开放组，手术时间长于开放组，差异均有统计学意义（P < 0.05）；两组患者术后各时段腰痛视觉模拟评分法（VAS）较术前明显降低，腰椎功能日本骨科协会（JOA）评分较术前明显升高，差异均有统计学意义（P < 0.05）；DELTA组术后各时段腰痛VAS明显低于开放组，腰椎功能JOA评分明显高于开放组，差异均有统计学意义（P < 0.05）；两组患者术后末次随访时，改良MacNab标准比较，差异无统计学意义（P > 0.05）。结论 Delta内镜下腰椎减压融合术治疗GILDH，疗效显著，具有出血量少、手术切口小和术后康复快等优势；在跨越Delta内镜学习曲线和优化手术流程后，该技术可以成为常规开放手术的替代方案。

Abstract:

Objective To explore the clinical efficacy of Delta endoscopic lumbar decompression fusion for the treatment of giant lumbar disc herniation (GILDH).Method A retrospective analysis was performed on 36 cases of GILDH from April 2020 to May 2022, including 18 cases in the Delta group and 18 cases in the open group. There was no statistically significant difference in gender, age, and responsible section between the two groups of patients. Compare the surgical time, perioperative indicators, and clinical efficacy between the two groups.Results The intraoperative bleeding and drainage volume in the Delta group were lower than those in the open group, the incision length and hospital stay were shorter than those in the open group, the degree of paraspinal muscle injury was lighter than that in the open group, and the surgical time was longer than that in the open group, with statistical significance (P < 0.05); The lumbago visual analogue scale (VAS) of the two groups of patients at each postoperative period was significantly reduced compared to preoperative, and the lumbar spine function score of the Japanese Orthopaedic Association (JOA) was significantly increased compared to preoperative, with statistical significance (P < 0.05); The lumbago VAS of the Delta group was significantly lower than that of the open group at all postoperative stages, and the lumbar spine function JOA score was significantly higher than that of the open group, with statistical significance (P < 0.05); There was no statistically significant difference in the modified MacNab score between the two groups of patients at the last follow-up after surgery (P > 0.05).Conclusion Delta endoscopic lumbar decompression fusion for GILDH has significant therapeutic effects, with advantages such as less bleeding, small surgical incision, and fast postoperative recovery; After crossing the Delta endoscopic learning curve and optimizing the surgical process, this technology can become an alternative to conventional open surgery.