Gao Hangfei, Gui Jiancao, Jiang Yiqiu, Xu Yan, Xu Bo, Xiong Mingyue, Cui Yongguang
Department of Traumatology, the First Affiliated Hospital of Henan University of Science & Technology, Luoyang Henan, 471000, P.R.China.
Department of Orthopedics, Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Feb 15;34(2):157-161. doi: 10.7507/1002-1892.201907021.
To identify effect of quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy (PELD) treatment in patients with L , S lumbar disc herniation.
A retrospective study between May 2014 and March 2016 was conducted, including 100 patients with disc herniation at L , S , who were initially enrolled for the PELD treatment. Among them, 66 patients were successfully treated with PELD (group A), and the other 34 patients failed to perform puncture, catheterization, or microscopical operation due to the influence of iliac bone and other peripheral bone structures and treated with alternative surgical plans. By analyzing the X-ray films of lumbar vertebrae (including bilateral ilium) of the two groups before operation, the concept of ilium height rate and ilium angle rate was put forward innovatively. The ilium height rate and ilium angle rate of the two groups were measured and compared, and the diagnostic critical points of ilium height rate and ilium angle rate were determined by ROC curve analysis.
The ilium height rate was 0.61±0.09, 0.74±0.05 and the ilium angle rate was 0.66±0.08, 0.80±0.08 in groups A and B, respectively, showing significant differences between the two groups ( =69.729, =0.000; =65.165, =0.000). ROC curve analysis showed that the critical point of ilium height rate was 0.71 (area under ROC curve was 0.927, =0.000), and the critical point of ilium angle rate was 0.75 (area under ROC curve was 0.965, =0.000).
PELD is not recommended for patients with L , S intervertebral disc herniation, when the ilium height rate is greater than 0.71 and/or the ilium angle rate is greater than 0.75. Other surgical plans such as transpedicular approach, transpedicular approach, or open surgery, should be recommended to reduce the risk of surgery and the pain of patients.
探讨髂骨高度量化指标对L、S腰椎间盘突出症患者经皮内镜下腰椎间盘切除术（PELD）治疗入路的影响。
对2014年5月至2016年3月期间100例L、S椎间盘突出症患者进行回顾性研究，这些患者最初均入选PELD治疗。其中，66例患者成功接受PELD治疗（A组），另外34例患者因髂骨及其他周围骨骼结构的影响未能进行穿刺、置管或显微手术，转而采用其他手术方案治疗。通过分析两组患者术前腰椎（包括双侧髂骨）X线片，创新性地提出髂骨高度率和髂骨角度率的概念。测量并比较两组的髂骨高度率和髂骨角度率，通过ROC曲线分析确定髂骨高度率和髂骨角度率的诊断临界点。
A组和B组的髂骨高度率分别为0.61±0.09、0.74±0.05，髂骨角度率分别为0.66±0.08、0.80±0.08，两组间差异有统计学意义（=69.729，=0.000；=65.165，=0.000）。ROC曲线分析显示，髂骨高度率的临界点为0.71（ROC曲线下面积为0.927，=0.000），髂骨角度率的临界点为0.75（ROC曲线下面积为0.965，=0.000）。
当髂骨高度率大于0.71和/或髂骨角度率大于0.75时，不建议对L、S椎间盘突出症患者采用PELD治疗。应推荐其他手术方案，如经椎弓根入路、经椎弓根入路或开放手术，以降低手术风险和患者痛苦。
