经皮脊柱内镜下腰椎髓核摘除联合纤维环缝合治疗腰椎间盘突出的临床效果

Clinical Efficacy of Percutaneous Spinal Endoscopic Lumbar Discectomy Combined with Annular Suture in the Treatment of Lumbar Disc Herniation

摘要: 目的：探讨经皮脊柱内镜下腰椎髓核摘除联合纤维环缝合治疗腰椎间盘突出症的临床效果。方法：回顾性分析2021年3月~2024年2月深圳市福永人民医院医治的腰椎间盘突出症患者186例，男101例，女85例，年龄32~60岁。其中对照组91例患者采用经皮脊柱内镜下腰椎髓核摘除术，术中不缝合破损或切开的纤维环；实验组95例采用经皮脊柱内镜下腰椎髓核摘除联合纤维环缝合，术中使用纤维环缝合器缝合破损或切开的纤维环，分析比较两组手术时间、出血量、腰腿痛视觉模拟评分(VAS)、腰椎ODI功能障碍指数以及术后复发率情况。结果：所有患者均获随访，术中均未出现神经根损伤、脑脊液漏，未出现术中改变术式改为开放性手术，随访时间3个月。两组患者手术时间对照组小于实验组，差异有统计学意义(p < 0.05)，出血量两组相当，差异无统计学意义(p > 0.05)，两组患者术后3个月腰腿痛VAS评分显著低于术前，差异有统计学意义(p < 0.05)；两组患者术后3个月腰椎ODI指数低于术前，差异有统计学意义(p < 0.05)。术后3个月内对照组复发4例，1例予椎间盘切除植骨融合术，3例保守治疗后症状缓解；实验组复发2例，保守治疗后症状均缓解，其余患者影像学复查无复发，无手术节段失稳。结论：经皮脊柱内镜下腰椎髓核摘除联合纤维环缝合能明显改善患者腰腿部疼痛和腰椎功能，降低术后复发率，临床效果满意。

Abstract: Objective: To explore the clinical efficacy of percutaneous endoscopic lumbar discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation. Methods: A retrospective analysis was conducted on 186 patients with lumbar disc herniation treated at Shenzhen Fuyong People’s Hospital from March 2021 to February 2024, including 101 males and 85 females, aged from 32 to 60 years old. Among them, 91 patients in the control group underwent percutaneous endoscopic lumbar discectomy without suture of ruptured or incised annulus fibrosus during operation; 95 patients in the experimental group received percutaneous endoscopic lumbar discectomy combined with annulus fibrosus suture, and the ruptured or incised annulus fibrosus was sutured with an annulus fibrosus suturing device intraoperatively. The operation time, intraoperative blood loss, Visual Analogue Scale (VAS) scores of lumbocrural pain, Oswestry Disability Index (ODI) of lumbar spine and postoperative recurrence rate were compared between the two groups. Results: All patients were followed up for 3 months. No intraoperative complications such as nerve root injury, cerebrospinal fluid leakage occurred, and no conversion to open surgery was performed in any case. The operation time of the control group was significantly shorter than that of the experimental group, with statistically significant difference (p < 0.05). There was no significant difference in intraoperative blood loss between the two groups (p > 0.05). The postoperative 3-month VAS scores of lumbocrural pain and lumbar ODI scores in both groups were markedly lower than those before operation, with statistically significant differences (all p < 0.05). Within 3 months after surgery, 4 cases of recurrence occurred in the control group: 1 case was treated with discectomy combined with bone graft fusion, and the other 3 cases achieved symptom relief after conservative treatment. There were 2 recurrent cases in the experimental group, all of whom obtained symptom relief after conservative treatment. No recurrence and instability of operative segment were found in the remaining patients by imaging reexamination. Conclusion: Percutaneous endoscopic lumbar discectomy combined with annulus fibrosus suture can significantly relieve lumbocrural pain, improve lumbar function and reduce postoperative recurrence rate, with satisfactory clinical therapeutic effect.