经皮内窥镜联合Coflex棘突间动力重建系统在腰椎间盘突出症中的应用研究
Application of Percutaneous Endoscope Combined with Coflex Interspinous Process Dynamic Reconstruction System in Lumbar Disc Herniation
摘要: 目的：探究经皮内窥镜联合Coflex棘突间动力重建系统在腰椎间盘突出症中的应用效果。方法：本研究选取自2016年6月~2018年6月入我院脊柱外科的128例腰椎间盘患者，按照随机数字法进行分组，即联合组和单纯内镜组。联合组采用经皮内窥镜联合Coflex棘突间动力重建系统，单纯内镜组采用经皮内窥镜下腰椎间盘髓核摘除术，每个组又分成2个节段，即L4~L5和L5~S1节段。统计比较两组术前、术后以及末次随访时侧位X线片测得病变节段椎体间和相邻椎体间腹侧高度(ventral intervertebral space height, VH)、椎体间背侧高度(dorsal intervertebral space height, DH)、椎间孔高度(intervertebral foramen height, IFH)，采用Oswestry功能障碍指数(ODI)及日本骨科协会(JOA)评分，疼痛视觉模拟评分(VAS)评价临床疗效。结果：1) 2组患者一般基准资料比较无统计学差异(P > 0.05)。2) 2组患者手术资料比较结果显示，联合组手术时间比单纯内镜组长(P < 0.05)；联合组术中出血量比单纯内镜组多(P < 0.05)；联合组麻醉时间比单纯内镜组长(P < 0.05)。3) 2组术前、术后和随访的ODI，JOA评分和VAS评分比较结果显示：2组术前ODI，JOA评分和VAS评分比较无统计学差异(P > 0.05)；2组术后ODI，JOA评分和VAS评分比较有统计学差异(P < 0.05)；末次随访ODI，JOA评分和VAS评分比较有统计学差异(P < 0.05)。4) 2组术前VH，DH，IFH等比较无统计学差异(P > 0.05)；2组术后VH比较无统计学差异(P > 0.05)；末次随访VH比较无统计学差异(P > 0.05)。2组术后和末次随访DH，IFH比较具有统计学差异(P < 0.05)。结论：经皮内窥镜联合Coflex棘突间动力重建系统对于微创治疗腰椎间盘突出症的患者具有良好的短期和长期效果。
Abstract: Objective: To explore the effect of percutaneous endoscope combined with Coflex interspinous process dynamic reconstruction system in lumbar disc herniation. Methods: From June 2016 to June 2018, 128 patients with lumbar intervertebral disc were divided into combined group and endoscope group according to the random number method. The combined group was treated with percutaneous endoscope combined with Coflex interspinous process dynamic reconstruction system, and the simple endoscopic group was treated with percutaneous endoscope discectomy of nucleus pulposus. Each group was divided into two segments: L4~L5 and L5~S1. Ventral intervertebral space height (VH), Dorsal intervertebral space height (DH) and Intervertebral foramen height (IFH) were conducted between the two groups before operation. After operation and at the last follow-up, Oswestry dysfunction index (ODI) and score of Japanese orthopedic association (JOA) were measured. Pain visual analogue score (VAS) was used to evaluate the clinical efficacy. Results: 1) There was no significant difference in general baseline data between the two groups (P > 0.05). 2) The operative time of the combined group was longer than that of the group of endoscope alone (P < 0.05), the amount of intraoperative bleeding in the combined group was more than that of the group of endoscope alone (P < 0.05), and the duration of anesthesia in the combined group was longer than that in the group of simple endoscopy (P < 0.05). 3) The comparison of VAS score and ODI JOA score before operation, operation and follow-up in two groups showed that there was no significant difference in ODI JOA score and VAS score between the two groups before and after operation (P > 0.05). There was a significant difference in VAS score and ODI JOA score between the two groups after operation (P < 0.05). At the last follow-up, there was a significant difference be-tween the VAS score and the ODI JOA score (P < 0.05). 4) There was no significant difference in VH between the two groups (P > 0.05), and there was no significant difference in VH between the two groups (P > 0.05), but there was no significant difference between the last follow-up group (P > 0.05) and the last follow-up group (P < 0.05). Conclusion: Percutaneous endoscopy combined with Coflex interspinous dynamic reconstruction system has a good short-term and long-term effect for minimally invasive treatment of lumbar disc herniation.
文章引用：邵莉剑. 经皮内窥镜联合Coflex棘突间动力重建系统在腰椎间盘突出症中的应用研究[J]. 医学诊断, 2020, 10(4): 245-253. https://doi.org/10.12677/MD.2020.104039

参考文献

[1] Parisini, P., Di Silvestre, M., Greggi, T., et al. (2001) Lumbar Disc Excision in Children and Adolescents. Spine (Phila Pa 1976), 26, 1997-2000. [Google Scholar] [CrossRef] [PubMed]
[2] Kuh, S.U., Kim, Y.S., Cho, Y.E., et al. (2005) Surgical Treatments for Lumbar Disc Disease in Adolescent Patients; Chemonucleolysis/ Microsur-gical Discectomy/ PLIF with Cages. Yonsei Medical Journal, 46, 125-132. [Google Scholar] [CrossRef] [PubMed]
[3] 蒋毅, 左如俊, 吴磊, 等. 微创内窥镜下经不同入路治疗重度脱出移位腰椎间盘突出症[J]. 中国骨伤, 2017, 30(2): 100-104.
[4] Ruetten, S., Komp, M., Mark, H., et al. (2008) Full-Endoscopic Interlaminar and Transforaminal Lumbar Discectomy versus Conventional Microsurgical Technique: A Prospective, Randomized, Controlled Study. Spinal (Phila Pa 1976), 33, 931-939. [Google Scholar] [CrossRef] 
[5] Park, J.S., Chor, S.E., Cho, T.K., et al. (2013) Recurrence Rate after Herniotomy Only versus Discectomy in Lumbar Disc Herniation. Korean Journal of Spine, 10, 227-231. [Google Scholar] [CrossRef] [PubMed]
[6] 徐丁, 徐华梓, 陈一横, 等. 单纯髓核摘除术与髓核摘除辅助Coflex动态固定术治疗腰椎间盘突出症的疗效对比研究[J]. 中华外科杂志, 2013, 51(2): 147-151.
[7] Wang, H.W., Cheng, J.W., Xiao, H., et al. (2013) Adolescent Lumbar Disc Herniation: Experience from a Large Minimally Invasive Treatment Centre for Lumbar Degenerative Disease in Chongqing, China. Clinical Neurology and Neurosurgery, 115, 1415-1419. [Google Scholar] [CrossRef] 
[8] Ruetten, S., Komp, M. and Godolias, G. (2005) An Extreme Lateral Access for the Surgery of Lumbar Disc Herniations inside the Spinal Canal Using the Full-Endoscopic Uniportal Transforaminal Approach-Technique and Prospective Results of 463 Patients. Spine (Phila Pa 1976), 30, 2570-2578. [Google Scholar] [CrossRef] [PubMed]
[9] Hoogland, T., van den Brekel-Dijkstra, K., Schubert, M., et al. (2008) Endoscopic Transforaminal Discectomy for Recurrent Lumbar Disc Herniation: A Prospective, Cohort Evaluation of 262 Consecutive Cases. Spine (Phila Pa 1976), 33, 973-978. [Google Scholar] [CrossRef] 
[10] Ruetten, S., Komp, M., Godolias, G., et al. (2006) A New Full-Endoscopic Technique for the Interlaminar Operation of Lumbar Disc Herniations Using 6-Mm Endoscopes: Prospective 2-Year Results of 331 Patients. Minimally Invasive Neurosurgery, 49, 80-87. [Google Scholar] [CrossRef] [PubMed]
[11] 梁昌详, 昌耘冰, 顾宏林, 等. 动态内固定Coflex系统治疗腰椎退变性疾病:椎间孔高度恢复与疗效[J]. 中国组织工程研究, 2014(13): 2065-2070.
[12] 周洋, 徐华梓, 池永龙, 等. Coflex动态稳定装置在L5/S1退变性疾病中的应用[J]. 中国脊柱脊髓杂志, 2011, 21(8): 627-632.
[13] Yeung, A.T. and Tsou, P.M. (2002) Posterolateral Endoscopic Excision for Lumbar Disc Herniation: Surgical Technique, Outcome, and Complications in 307 Consecutive Cases. Spine (Phila Pa 1976), 27, 722-731. [Google Scholar] [CrossRef] [PubMed]
[14] Choi, G., Lee, S.H., Raiturker, P.P., et al. (2006) Per-cutaneous Endoscopic Interlaminar Discectomy for Intracanalicular Disc Herniation at L5-S1 Using a Rigid Working Channel Endoscope. Neurosurgery, 58, 59-68. [Google Scholar] [CrossRef] 
[15] Kumar, N., Shah, S.M., Ng, Y.H., et al. (2014) Role of Coflex as an Adjunct to Decompression for Symptomatic Lumbar Spinal Stenosis. Asian Spine Journal, 8, 161-169. [Google Scholar] [CrossRef] [PubMed]