纤维环缝合联合椎间孔镜下髓核摘除术治疗腰椎间盘突出症的临床疗效

Clinical efficacy of annulus fibrosus suture combined with percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation

摘要:

目的 分析纤维环缝合（AFS）联合椎间孔镜下髓核摘除术（PELD）治疗腰椎间盘突出症（LDH）的临床疗效。方法 回顾性分析2020年3月－2023年12月于该院骨科治疗的202例LDH患者的临床资料。根据不同手术方法，将患者分为PELD组（行单纯PELD治疗，93例）和联合组（行AFS联合PELD治疗，109例）。比较两组围手术期相关指标；比较两组术前和术后3个月的腰椎功能、腰腿疼痛程度、神经功能和腰椎退行性病变情况；比较两组住院期间并发症发生情况和术后随访1年的复发情况。结果 联合组手术时间明显长于PELD组，差异有统计学意义（P < 0.05）；两组透视次数、出血量和住院时间比较，差异均无统计学意义（P > 0.05）。术后3个月，两组腰椎Oswestry功能障碍指数（ODI）、腰痛视觉模拟评分法（VAS）评分和腿痛VAS评分明显低于术前，差异均有统计学意义（P < 0.05），但两组间比较，差异均无统计学意义（P > 0.05）。术后3个月，两组胫神经潜伏期和腓总神经潜伏期明显短于术前，胫神经的神经传导速度和腓总神经的神经传导速度明显快于术前，差异均有统计学意义（P < 0.05），但两组间比较，差异均无统计学意义（P > 0.05）。术后1年，两组腰椎前凸角和椎管面积大于术前，差异均有统计学意义（P < 0.05），但两组间比较，差异均无统计学意义（P > 0.05）；术后1年，PELD组责任椎间隙高度明显低于术前，且联合组明显高于PELD组，差异均有统计学意义（P < 0.05）。住院期间，两组并发症总发生率［2.15%（2/93）和2.75%（3/109）］比较，差异无统计学意义（P > 0.05）。联合组术后1年复发率为0.92%（1/109），明显低于PELD组的7.53%（7/93），差异有统计学意义（P < 0.05）。结论 单用PELD和AFS联合PELD治疗LDH，均可改善患者腰椎功能、腰腿痛和神经功能，安全性高。联合治疗的手术时间较单用PELD长，但其腰椎退行性病变改善情况较单用PELD好，且复发率较单用PELD低。

Abstract:

Objective To analyze the clinical efficacy of annulus fibrosus suture (AFS) combined with percutaneous endoscopic lumbar discectomy (PELD) on the treatment of lumbar disc herniation (LDH).Methods A retrospective analysis was conducted on the clinical data of 202 patients with LDH who were treated in the orthopedics department of this hospital from March 2020 to December 2023. According to different surgical methods, the patients were divided into the PELD group (receiving simple PELD treatment, 93 cases) and the combined group (AFS combined with PELD treatment, 109 cases). Compare the perioperative related indicators of the two groups; the lumbar function, the degree of low back and leg pain, the neurological function and the degeneration of lumbar intervertebral discs were compared between the two groups before the operation and 3 months after the operation. The occurrence of complications during hospitalization and the recurrence during the 1-year postoperative follow-up were compared between the two groups.Results The operation time of the combined group was significantly longer than that of the PELD group, and the difference was statistically significant (P < 0.05); There were no statistically significant differences in the number of fluoroscopy sessions, blood loss and hospital stay between the two groups (P > 0.05). Three months after the operation, the Oswestry Disability Index (ODI), the visual analogue scale (VAS) score for low back pain, and the VAS score for leg pain in both groups were significantly lower than those before the operation, and the differences were statistically significant (P < 0.05). However, when comparing the two groups, the differences were not statistically significant (P > 0.05). Three months after the operation, the latencies of the tibial nerve and the common peroneal nerve in both groups were significantly shorter than those before the operation, the nerve conduction velocities of the tibial nerve and the common peroneal nerve were significantly faster than those before the operation, and the differences were statistically significant (P < 0.05). However, when comparing the two groups, there were no statistically significant differences (P > 0.05). One year after the operation, the lumbar lordosis angle and spinal canal area in both groups were larger than those before the operation, and the differences were statistically significant (P < 0.05), but there were no statistically significant differences between the two groups (P > 0.05). One year after the operation, the height of the responsible intervertebral space in the PELD group was significantly lower than that before the operation, and that in the combined group was significantly higher than that in the PELD group. The differences were statistically significant (P < 0.05). During hospitalization, there was no statistically significant difference in the total incidence of complications between the two groups [2.15% (2/93) and 2.75% (3/109)] (P > 0.05). The recurrence rate of the combined group one year after surgery was 0.92% (1/109), which was significantly lower than 7.53% (7/93) in the PELD group, and the difference was statistically significant (P < 0.05).Conclusion Both PELD and AFS combined with PELD in the treatment of LDH can improve lumbar function, low back and leg pain, and neurological function of patients, with high safety. The operation time of combined therapy is longer than that of simple PELD, but the improvement of lumbar intervertebral disc degeneration is better than that of simple PELD, and the recurrence rate is lower than that of simple PELD.