Yuan Shuo, Wu Qichao, Zang Lei, Fan Ning, Du Peng, Wang Aobo, Wang Tianyi, Si Fangda, Li Jian, Kong Xiaochuan
Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Neurospine. 2022 Sep;19(3):586-593. doi: 10.14245/ns.2244346.173. Epub 2022 Sep 30.
Posterior apophyseal ring fracture (PARF) is an uncommon disorder that is usually accompanied by lumbar disc herniation (LDH). The aim of this study to describe the 8-year experience of performing minimally invasive treatment of PARF, giving particular attention to surgical technique and clinical outcome.
We reviewed 1,324 consecutive patients with LDH seen in our department between 2013 and 2020. Forty-eight patients (3.63%) were enrolled who were diagnosed with PARF associated with LDH and underwent transforminal endoscopic lumbar discectomy (TELD). Mean duration of the final postoperative follow-up was 5.1 years. The control group was comprised of 50 patients diagnosed with LDH without PARF at the same facility. Data on clinical outcomes were analyzed.
The mean operation time in the PARF group was 105.4 minutes, which was longer than the mean operation time of the control group (83.9 minutes) (p = 0.001). Surgical complications, including dural tears (6.3%) and surgical instrument rupture (4.2%) were more common in the PARF group (p = 0.025). However, there was no significant difference in the proportion of excellent and good results and recurrence rates between the LDH patients with and those without PARF, respectively.
TELD is a safe and effective minimally invasive approach for the treatment of PARF. However, minimally invasive techniques may require longer operation time and steeper learning curve for inexperienced surgeons. The separation and removal of bone fragments, a key step in the procedure, requires patience and care to prevent rupture, residual surgical instruments, and leakage of cerebrospinal fluid.
后纵韧带下骨皮质环骨折（PARF）是一种罕见的疾病，通常伴有腰椎间盘突出症（LDH）。本研究旨在描述8年来对PARF进行微创治疗的经验，特别关注手术技术和临床结果。
我们回顾了2013年至2020年期间在我科连续就诊的1324例LDH患者。48例（3.63%）被诊断为与LDH相关的PARF并接受了经椎间孔内镜下腰椎间盘切除术（TELD）的患者被纳入研究。术后最终随访的平均时间为5.1年。对照组由在同一机构诊断为无PARF的50例LDH患者组成。对临床结果数据进行了分析。
PARF组的平均手术时间为105.4分钟，长于对照组的平均手术时间（83.9分钟）（p = 0.001）。PARF组的手术并发症，包括硬脊膜撕裂（6.3%）和手术器械破裂（4.2%）更为常见（p = 0.025）。然而，有PARF和无PARF的LDH患者之间的优良率和复发率比例分别无显著差异。
TELD是治疗PARF的一种安全有效的微创方法。然而，对于经验不足的外科医生来说，微创技术可能需要更长的手术时间和更陡峭的学习曲线。手术过程中的关键步骤——骨块的分离和去除，需要耐心和细心，以防止破裂、手术器械残留和脑脊液漏出。
