脊柱内镜侧后路联合减压术治疗腰神经根双卡综合征的临床疗效观察

Clinical observation of spinal endoscopic lateral posterior combined decompression surgery for the treatment of lumbar nerve root double crush syndrome

摘要:

目的 观察脊柱内镜侧后路联合减压术治疗腰神经根双卡综合征（DCS）的临床疗效、可行性、安全性和有效性。方法 回顾性分析2018年9月－2023年9月于该院就诊的50例腰椎退行性病变致腰神经根DCS患者的临床资料，根据手术方法不同，将患者分为观察组（37例）和对照组（13例）。观察组行脊柱内镜侧后路联合减压术治疗，对照组行非手术治疗。比较两组患者治疗前、治疗后1周、治疗后3个月、治疗后6个月和治疗后12个月的疼痛视觉模拟评分法（VAS）评分、Oswestry功能障碍指数（ODI）和日本骨科协会（JOA）评分。末次随访时，采用改良Macnab标准，评估临床疗效；采用腰椎MRI检查，评估椎间隙高度和椎间盘退变改良Pfirrmann分级。比较两组患者治疗的安全性（包括：并发症发生情况、复发情况和转手术治疗情况）。结果 50例患者均顺利完成治疗。两组患者术后VAS评分和ODI呈下降趋势，JOA评分呈升高趋势，观察组术后各时点VAS评分和ODI明显低于术前，且明显低于对照组，术后各时点JOA评分明显高于术前，且明显高于对照组，差异均有统计学意义（P < 0.05）；观察组优良率为86.49%，明显高于对照组的76.92%，差异有统计学意义（P < 0.05）；两组患者末次随访时，椎间隙高度和椎间盘退变Pfirrmann分级比较，差异均无统计学意义（P > 0.05）。两组患者围手术期均未出现神经损伤和脑脊液漏等严重并发症，观察组术后1例出现下肢放射性疼痛；观察组1例术后3个月出现腰椎间盘再突出；对照组有3例转手术治疗。结论 与非手术治疗相比，脊柱内镜侧后路联合减压术可更为安全、有效地缓解腰神经根DCS患者的疼痛，改善下肢功能，且早、中期临床疗效好。值得临床推广应用。

Abstract:

Objective To observe the clinical efficacy, feasibility, safety and effectiveness of spinal endoscopic lateral posterior combined decompression in the treatment of lumbar nerve root double crush syndrome (DCS).Methods A retrospective analysis was conducted on the clinical data of 50 patients with lumbar nerve root DCS caused by disc degenerative change from September 2018 to September 2023. The patients were divided into the observation group (37 cases) and the control group (13 cases) according to different surgical methods. The observation group was treated with spinal endoscopic lateral posterior combined decompression technique, while the control group was treated with non-surgical techniques. The visual analogue scale (VAS) score for pain, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score of the two groups of patients were compared before treatment, 1 week after treatment, 3 months after treatment, 6 months after treatment, and 12 months after treatment. At the last follow-up, the modified Macnab criteria was used to evaluate the clinical efficacy. Lumbar MRI was used to assess the height of the intervertebral space and the modified Pfirrmann classification standard for intervertebral disc degeneration. Evaluate the safety of this surgery (including the occurrence of complications, recurrence and conversion to surgical treatment).Results All 50 patients successfully completed the treatment without any serious complications. The VAS score and ODI of the two groups of patients showed a downward trend after the operation, while the JOA score showed an upward trend, the VAS score and ODI of the observation group at each time point after the operation were significantly lower than those before the operation, and were also significantly lower than those of the control group. The JOA score was significantly higher than that before the operation, and was also significantly higher than that of the control group. The differences were statistically significant (P < 0.05). The excellent and good rate of the observation group was 86.49%, significantly higher than 76.92% of the control group, and the difference was statistically significant (P < 0.05). At the last follow-up of the two groups of patients, there was no statistically significant difference in the height of the intervertebral space and the Pfirrmann grade of intervertebral disc degeneration (P > 0.05). Neither of the two groups of patients had serious complications such as nerve injury and cerebrospinal fluid leakage during the perioperative period. In the observation group, one patient had radiating pain in the lower limb after the operation. In the observation group, one case developed lumbar intervertebral disc re-protrusion 3 months after the operation. In the control group, 3 cases were transferred to surgical treatment.Conclusion Compared with non-surgical treatment, spinal endoscopic lateral and posterior combined decompression can more safely and effectively relieve the pain degree of lumbar nerve root DCS patients, improve lower limb function, and has good clinical efficacy in the early and middle stages. It is worthy of clinical promotion and application.