Lou Chao, Yu Wei-Yang, Chen Jian, He Deng-Wei
Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China.
Zhongguo Gu Shang. 2022 May 25;35(5):448-53. doi: 10.12200/j.issn.1003-0034.2022.05.008.
To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion.
From February 2010 to June 2018, 64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group, there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy, including 27 cases of single segment fusion and 6 cases of double segment fusion, aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group, there were 22 males and 9 females performed with traditional open fusion revision, including 25 cases of single-segment fusion and 6 cases of double segment fusion, aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time, intraoperative blood loss, fluoroscopy times, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed.
All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group, operation time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (<0.05), and the fluoroscopy times of observation group were significantly increased compared with control group(<0.05). The VAS of low back and lower limb, and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (<0.05). The VAS of low back at each point and ODI at 1, 3 months after operation in observation group was significantly reduced compared with control group(<0.05), however there was no significant difference in VAS for lower limb between two groups (>0.05). The difference of complications between two groups was statistically significant (<0.05).
Compared with traditional open fusion revision surgery, percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss, shortening ambulation time and the length of postoperative hospital stay, and promoting pain and functional improvement, and decrease incidence of complications. However, long-term clinical efficacy needs further study.
探讨经皮内镜下腰椎间盘切除术治疗腰椎融合术后相邻节段腰椎间盘突出症的临床效果。
回顾性分析2010年2月至2018年6月期间64例腰椎融合术后相邻节段腰椎间盘突出症患者，分为观察组和对照组。观察组男23例，女10例，行经皮内镜下腰椎间盘切除术，其中单节段融合27例，双节段融合6例，年龄55～83岁，平均（65.7±7.4）岁。对照组男22例，女9例，行传统开放融合翻修术，其中单节段融合25例，双节段融合6例，年龄51～78岁，平均（64.8±7.8）岁。记录手术时间、术中出血量、透视次数、术后下床活动时间及术后住院时间。采用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估临床疗效。观察两组并发症发生情况。
所有患者均随访至少2年。观察组患者平均随访（2.4±0.5）年。对照组患者平均随访（2.6±0.7）年。与对照组相比，观察组手术时间、术中出血量、术后下床活动时间及术后住院时间均显著减少（<0.05），观察组透视次数较对照组显著增加（<0.05）。两组末次随访时腰背部及下肢VAS、ODI较术前均显著改善（<0.05）。观察组术后各时间点腰背部VAS及术后1、3个月ODI较对照组显著降低（<0.05），但两组下肢VAS差异无统计学意义（>0.05）。两组并发症差异有统计学意义（<0.05）。
与传统开放融合翻修手术相比，经皮内镜下腰椎间盘切除术治疗腰椎融合术后相邻节段腰椎间盘突出症具有减少手术时间和术中出血量、缩短下床活动时间及术后住院时间、促进疼痛缓解和功能改善、降低并发症发生率等优点。然而，长期临床疗效仍需进一步研究。
