经45°穿刺与传统经椎间孔内镜脊柱系统技术在脊柱内镜减压术治疗L5/S1椎间盘突出症中的应用效果比较

Comparison study of the efficacy of spinal endoscopic decompression through 45° puncture versus traditional transforaminal endoscopic spinal system technique in the treatment of L5/S1 disc herniation

摘要:

目的 探讨经45°穿刺椎间孔入路脊柱内镜减压术治疗L₅/S₁节段腰椎间盘突出症（LDH）的疗效和安全性。方法 回顾性分析2021年1月－2023年1月该院骨科收治的130例L₅/S₁节段LDH患者的临床资料。按照手术方法的不同，将患者分为观察组（67例）和对照组（63例）。观察组采用45°穿刺经椎间孔入路脊柱内镜减压术，对照组采用传统经椎间孔内镜脊柱系统（TESSYS）技术行椎间孔入路脊柱内镜减压术。统计两组患者手术时间、X线透视时间和住院时间等围手术期指标；于术前、术后1 d、术后3个月、术后6个月和术后12个月，采用腰痛和下肢痛视觉模拟评分法（VAS）评分和Oswestry功能障碍指数（ODI）评估患者疼痛情况和腰椎功能；于术后12个月，采用改良MacNab标准评估总体疗效。结果 两组患者均顺利完成脊柱内镜减压术，观察组手术时间和术中X线透视时间明显短于对照组，差异均有统计学意义（P < 0.05）；两组患者住院时间比较，差异无统计学意义（P = 0.505）；两组患者术后1 d、术后3个月、术后6个月和术后12个月腰痛VAS评分、下肢痛VAS评分和ODI明显低于术前，差异均有统计学意义（P < 0.05）；观察组术后1 d和术后3个月的腰痛VAS评分、下肢痛VAS评分和ODI明显低于对照组，差异均有统计学意义（P < 0.05），两组患者术后6和12个月腰痛VAS评分、下肢痛VAS评分和ODI比较，差异均无统计学意义（P > 0.05）；术后12个月，观察组优良率为95.5%，与对照组的85.7%比较，差异无统计学意义（P = 0.054）；两组患者均未发生手术相关并发症；术后随访期间，对照组有6例（9.5%）因残留的突出物再次压迫神经根导致腰痛和下肢痛复发，观察组未出现术后复发，差异有统计学意义（P = 0.035）。结论 经45°穿刺技术和传统TESSYS技术行椎间孔入路脊柱内镜减压术治疗L₅/S₁节段LDH，均可取得满意的减压效果。但经45°穿刺技术可缩短手术时间和X线透视时间，术后早期的改善效果更为明显，且术后复发率低。值得临床推广应用。

Abstract:

Objective To investigate the efficacy and safety of spinal endoscopic decompression through 45° puncture foraminal approach in treatment of L₅/S₁ lumbar disc herniation (LDH).Methods Clinical data of 130 patients with L₅/S₁ level LDH from January 2021 to January 2023 were retrospectively analyzed. These patients were divided into two groups based on the spinal endoscopic surgery approach. Observation group (67 patients) underwent spinal endoscopic decompression via 45° puncture, while the control group (63 patients) underwent spinal endoscopic decompression using the traditional transforaminal endoscopic spinal system (TESSYS) technique. Perioperative indicators such as operation time, X-ray fluoroscopy time, and hospital stay were recorded for both groups. Visual analogue scale (VAS) scores for low back pain and lower limb pain, as well as the Oswestry disability index (ODI) were assessed before surgery and at 1 day, 3 months, 6 months, and 12 months after operation. The overall efficacy was evaluated using the modified MacNab criterion at 12 months postoperatively.Results All the patients in both groups successfully underwent spinal endoscopic decompression. The observation group had significantly shorter average operation time and intraoperative X-ray fluoroscopy time compared to the control group, the differences were statistically significant (P < 0.05). There was no significant difference in hospital stay between the two groups (P = 0.505). Compared to preoperative values, both groups showed a significant decreasing trend in VAS scores for low back pain, lower limb pain, and ODI at 1 day, 3 months, 6 months, and 12 months after operation, the differences were statistically significant (P < 0.05). The observation group had significantly low back pain VAS score, lower limb pain VAS score and ODI at 1 day and 3 months after operation compared to the control group (P < 0.05). There were no statistically significant differences in low back pain VAS score, lower limb pain VAS score and ODI between the two groups 6 and 12 months after operation (P > 0.05). At 12 months after operation, the excellent and good rate was 95.5% in observation group and 85.7% in control group, with no significant difference between the two groups (P = 0.054). No surgery-related complications occurred in either group. During postoperative follow-up, 6 patients (9.5%) in control group experienced recurrence of low back pain and lower limb pain due to recompression of nerve roots by residual herniated material, while no recurrence was observed in observation group, the difference was statistically significant (P = 0.035).Conclusion Both the 45° puncture technique and the traditional TESSYS technique can achieve satisfactory decompression effects in patients with LDH at the L₅/S₁ segment undergoing transforaminal spinal endoscopic decompression surgery. However, the 45° puncture technique can shorten the operation time and X-ray fluoroscopy time, resulting in more pronounced early postoperative improvement and a lower recurrence rate. It is worthy clinical application.