Hao Yingjie, Liu Tao, Yu Lei, Ma Caoyuan, Liu Yawei, Li Zhilei, Zhang Di
Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052,
Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Feb 15;31(2):191-196. doi: 10.7507/1002-1892.201608062.
To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH).
The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L in 30 cases and L , S in 22 cases. In 30 patients at L level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L , S level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment.
The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L , S level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L level and 12-20 months (mean, 17 months) in patients at L , S level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients ( <0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients ( <0.05), and the ROM of involved segment was significantly reduced compared with preoperative one ( <0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one ( >0.05).
PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.
评估经皮椎间孔镜椎间盘切除术（PTED）联合Coflex棘突间动态重建系统治疗青年腰椎间盘突出症（LDH）的疗效。
回顾性分析2013年2月至2015年3月期间52例行PTED联合Coflex治疗的LDH患者的临床资料。受累节段为L 30例，L 、S 22例。L 节段的30例患者中，男性18例，女性12例，平均年龄25岁（范围18 - 34岁），平均病程10个月（范围6 - 16个月）。L 、S 节段的22例患者中，男性10例，女性12例，平均年龄25.5岁（范围19 - 32岁），平均病程12个月（范围6 - 18个月）。记录手术时间和术中出血量。采用Oswestry功能障碍指数（ODI）和日本骨科学会（JOA）评分进行疗效评估。在术前和末次随访时拍摄X线片计算影像学指标，包括椎体前间隙高度（VH）、椎体后间隙高度（DH）、椎间孔高度（IFH）、受累节段的活动度（ROM）以及上相邻节段的ROM。
52例患者手术均成功完成。L 节段患者的手术时间和术中出血量分别为（89.7±16.5）分钟和（42.7±11.3）mL，L 、S 节段患者分别为（94.6±18.2）分钟和（47.6±13.4）mL。切口一期愈合。所有患者均获随访，L 节段患者随访12 - 18个月（平均16个月），L 、S 节段患者随访12 - 20个月（平均17个月）。末次随访时，所有患者的ODI和JOA评分与术前相比均显著改善（ <0.05）。X线片显示未发生Coflex松动、棘突骨折或关节突骨折等并发症。末次随访时，所有患者的VH、DH和IFH与术前相比均显著改善（ <0.05），受累节段的ROM与术前相比显著降低（ <0.05），但上相邻节段的ROM与术前相比无显著差异（ >0.05）。
PTED联合Coflex是治疗青年LDH安全有效的微创手术；然而，仍需进一步的临床研究。
