内窥镜下髓核摘除术联合纤维环修复治疗腰椎间盘突出症的临床评价

发布时间：2018-09-11 20:27

【摘要】：目的:1、分析内窥镜下腰椎髓核摘除术(MED)术后复发的危险因素。2、评价MED联合一次性纤维环缝合术治疗腰椎间盘突出症的安全性、临床疗效以及能否有效降低术后的复发率。方法:回顾性分析我院2011年6月至2014年3月收治的213例接受MED治疗的腰椎间盘突出症患者,男118例,女95例,平均38.07±13.23岁。记录年龄、体重指数、椎间盘退变程度、手术节段及突出类型等危险因素。回顾性分析我院2012年3月至2014年3月收治的符合纳入和排除标准的290例接受MED治疗的单节段腰椎间盘突出症患者,男160例,女130例,平均38.13±12.08岁。其中172例单纯行椎间盘镜髓核摘除术作为对照组,118例联合行纤维环缝合术作为缝合组。记录两组手术时间、出血量、术前及随访时视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。利用影像学资料测量术前及随访时手术节段椎间隙高度的变化。卡方检验分析MED术后复发与年龄、体重指数、突出节段及类型、椎间盘退变程度等因素关系。采用Logistic回归对危险因素进行多因素分析。结果:随访时间平均28.35±5.08个月(24～32个月)。两组平均手术时间和平均手术出血量比较无统计学差异(P0.05)。缝合组和对照组两组组内ODI评分、腰痛VAS评分、下肢痛VAS评分术前与术后3个月、末次随访比较差异均有统计学意义(P0.05),两组组间同时间对比无统计学差异(P0.05)。对照组末次随访椎间隙高度(8.29±1.43mm)较术前(10.34±1.74mm)降低19.83%,缝合组末次随访椎间隙高度(8.94±1.35mm)较术前(10.46±1.55mm)降低14.53%,两组组间差异无统计学差异(F=1.461,P=0.230)。对照组术后同节段复发14例,复发率为8.14%,再手术患者6例,再手术率3.49%。缝合组术后3例患者复发,复发率为2.54%,再手术患者1例,再手术率为0.85%.两组复发率比较有统计学差异(χ2=3.973,P=0.046),再手术率有统计学差异。单因素及多因素多因素Logistic回归分析显示椎间盘退变程度、突出类型、术后活动程度与术后再次突出复发具有统计学差异。结论:1、内窥镜下髓核摘除术联合纤维环缝合术治疗LDH操作简便、安全可行,同单纯髓核摘除术,均可获得满意的临床疗效。在严格适应症下,可有效降低腰椎髓核摘除术后的复发率及再手术率。2、椎间盘退变程度、突出类型及术后活动度为MED术后再次突出复发的危险因素。
[Abstract]:Objective to analyze the risk factors of recurrence of lumbar spinal nucleus pulposus resection (MED) under endoscope, and to evaluate the safety, clinical effect and effective reduction of recurrence rate of lumbar intervertebral disc herniation treated by MED combined with one-off annular suture. Methods: two hundred and thirteen patients with lumbar disc herniation treated with MED from June 2011 to March 2014 were analyzed retrospectively. There were 118 males and 95 females with an average age of 38.07 卤13.23 years. Age, BMI, degree of disc degeneration, surgical segment and type of herniation were recorded. From March 2012 to March 2014, 290 patients with single segment lumbar disc herniation (male 160, female 130, mean 38.13 卤12.08 years old) who met the criteria of inclusion and exclusion were analyzed retrospectively. 172 cases were treated as control group, 118 cases were treated with annular suture. The time of operation, blood loss, visual analogue scale (VAS) score before operation and follow-up were recorded. Oswestry dysfunction index (ODI).) was recorded in both groups. Imaging data were used to measure the height of intervertebral space before operation and during follow-up. Chi square test was used to analyze the relationship between recurrence and age, body mass index, herniation segment and type, disc degeneration and so on. The risk factors were analyzed by Logistic regression. Results: the mean follow-up time was 28.35 卤5.08 months (24 ~ 32 months). There was no significant difference between the two groups in the mean operative time and the mean amount of operative bleeding (P0.05). The ODI score, VAS score and lower extremity pain VAS score in the suture group and the control group were significantly higher than those in the control group before and 3 months after operation (P0.05), but there was no significant difference between the two groups in the same time (P0.05). The intervertebral space height of the control group (8.29 卤1.43mm) was 19.83% lower than that of the preoperative (10.34 卤1.74mm), and the intervertebral space height (8.94 卤1.35mm) of the last follow-up group was 14.53% lower than that of the pre-operation group (10.46 卤1.55mm). There was no significant difference between the two groups (F _ (1.461) P ~ (0.230). In the control group, there were 14 cases of recurrence in the same segment, the recurrence rate was 8.14%, and the reoperation rate was 3.49% in 6 cases of reoperation. In the suture group, the recurrence rate was 2.54, and the reoperation rate was 0.85. There was significant difference in recurrence rate between the two groups (蠂 2 / 3.973 P 0.046), and there was a statistical difference in the rate of reoperation. Univariate and multivariate Logistic regression analysis showed that the degree of disc degeneration, the type of herniation, the degree of postoperative activity and the recurrence of recurrent disc herniation were significantly different. Conclusion it is simple, safe and feasible to treat LDH with endoscopic excision of nucleus pulposus combined with annular suture, and satisfactory clinical effect can be obtained with the same simple extirpation of nucleus pulposus. Under strict indications, the recurrence rate and reoperation rate of lumbar nucleus pulposus can be reduced effectively. The degree of disc degeneration, the type of herniation and the postoperative activity are the risk factors of recurrence of recurrent herniation after MED.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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