超声骨刀辅助下单孔分体内镜治疗钙化型腰椎间盘突出症的临床疗效

谭芳; 张燕; 张锋; 胡鹏; 王明飞; 韩帅; 宋鑫; 于涛; 王健

doi:10.16766/j.cnki.issn.1674-4152.003752

超声骨刀辅助下单孔分体内镜治疗钙化型腰椎间盘突出症的临床疗效

doi: 10.16766/j.cnki.issn.1674-4152.003752

谭芳¹,
张燕¹,
张锋^1, ,,
胡鹏²,
王明飞³,
韩帅¹,
宋鑫¹,
于涛¹,
王健¹

1.
上海市浦东新区人民医院骨科，上海 201299
2.
滨州医学院附属医院脊柱外科，山东滨州 256603
3.
上海中医药大学附属普陀医院骨科，上海 200062

基金项目:

上海市浦东新区科技发展基金项目 PKJ2022-Y37

上海市自然科学基金项目 22ZR1455700

上海市浦东新区学科建设重点学科项目 PWZxk2022-16

详细信息

通讯作者:
张锋，E-mail：zhangfeng@shpdph.com

中图分类号: R681.53
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- 文章访问数: 18
- HTML全文浏览量: 11
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-03-01
- 网络出版日期: 2024-12-31

Clinical efficacy of single hole split endoscopy assisted by ultrasound bone knife in the treatment of calcified lumbar disc herniation

1.
Department of Orthopedics, Pudong New Area People's Hospital of Shanghai, Shanghai 201299, China

摘要

摘要: 目的探讨钙化型腰椎间盘突出症(CLDH)采用超声骨刀辅助单孔分体内镜下椎间盘切除术(OSED)治疗的临床疗效，为临床提供参考。方法回顾性分析2022年1月—2023年2月在上海市浦东新区人民医院骨科治疗的25例CLDH患者资料，患者均应用超声骨刀辅助完成OSED。观察手术出血量、手术时间、术后下床时间、切口长度、术中透视次数及围手术期并发症等情况。比较患者术前、术后腰痛和腿痛VAS评分及Oswestry功能障碍指数(ODI)；比较术前、术后3个月椎间盘CT横截面的钙化突出物面积；在末次随访时使用改良MacNab标准评估手术疗效。结果 25例患者均手术顺利，未发生严重血管神经损伤的并发症。切口长度为(2.01±0.26)cm，手术用时为(87.40±12.84)min，手术出血量为(52.40±28.33)mL，术中透视次数为(2.88±1.01)次，术后下床时间为(22.56±7.80)h。患者术后各时间段腰痛、腿痛VAS评分及ODI指数较术前均明显下降(P＜0.05)。与术前比较，术后3个月椎间盘CT横截面钙化物面积明显减小(P＜0.001)。患者手术优良率达到92.0%(23/25)。结论应用超声骨刀辅助OSED治疗CLDH的疗效满意，具有创伤小、钙化突出物切除充分、并发症少等优势。
- 单孔分体内镜 /
- 钙化型腰椎间盘突出症 /
- 超声骨刀 /
- 椎间盘切除术
Abstract: Objective To examine the clinical efficacy of ultrasonic osteotome-assisted one-hole split endoscopic discectomy (OSED) for calcified lumbar disc herniation (CLDH) and to provide a clinical reference point. Methods A retrospective analysis was conducted on 25 patients with CLDH who were treated at the Department of Orthopaedics in Shanghai Pudong New Area People's Hospital between January 2022 and February 2023. All patients underwent osteosynthesis with the assistance of an ultrasonic bone knife. It is crucial to meticulously observe and document the extent of surgical bleeding, the duration of the surgical procedure, the postoperative period required for patients to be able to get out of bed, the length of the incision, the frequency of intraoperative fluoroscopy, and any perioperative complications. A comparison of the visual analogue scale (VAS) and Oswestry disability Index (ODI) scores for low back pain and leg pain before and after surgery will be conducted. Furthermore, the area of calcified protrusions on the CT cross-section of intervertebral discs before and three months after surgery will be evaluated. Finally, the modified MacNab criteria will be employed to evaluate the surgical efficacy at the conclusion of the follow-up period. Results All 25 patients underwent surgical intervention without any significant complications, including vascular or nerve injury. The mean length of the incision was (2.01±0.26) cm, the mean surgical time was (87.40±12.84) min, the mean surgical bleeding volume was (52.40±28.33) mL, the mean frequency of intraoperative fluoroscopy was (2.88±1.01) times, and the mean postoperative time to get out of bed was (22.56±7.80) h. The VAS score and ODI index for lower back pain and leg pain in patients at different time points after surgery exhibited a statistically significant reduction compared to the pre-surgical period (P < 0.05). Moreover, the area of calcified material in the CT cross-section of the intervertebral disc demonstrated a significant reduction at the three-month post-surgical mark in comparison to the pre-surgical level (P < 0.001). The proportion of patients who were rated as excellent or good using the revised MacNab criteria was 92.0% (23/25). Conclusion The application of ultrasonic osteotome assisted OSED in the treatment of CLDH has satisfactory therapeutic effects, with advantages such as minimal trauma, sufficient removal of calcified protrusions, and fewer complications.
- One-hole split endoscopic /
- Calcified lumbar disc herniation /
- Ultrasonic osteotome /
- Discectomy

HTML全文

图 1 L₅~S₁椎间盘突出症(钙化型)手术过程和影像学图片

注：图A、B为患者术前CT和MRI检查，显示L₅~S₁右侧椎间盘突出，突出物钙化，压迫神经及硬膜囊；图C为术后2个月CT检查，显示钙化的突出组织彻底切除，右侧关节突关节破坏较轻；图D为手术同一切口内将器械和内镜分开；图E显示内镜下视野清晰，神经根减压彻底；图F为术中切除的髓核及硬化组织；图G显示皮肤切口较小。

Figure 1. Surgical procedure and imaging of L₅ - S₁ calcified lumbar disc herniation

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表 1 25例单节段CLDH患者不同时间点腰腿痛VAS评分和ODI指数比较(x±s)

Table 1. Comparison of VAS scores for low back and leg pain, and ODI index at different time points in 25 patients with single-segment CLDH (x±s)

时间	腰痛VAS评分(分)	腿痛VAS评分(分)	ODI指数(%)
术前	5.92±1.22	6.64±0.86	61.76±7.76
术后3 d	2.68±0.69^a	2.40±0.58^a
术后3个月	1.88±0.33^ab	1.72±0.54^ab	27.96±2.38^a
术后12个月	1.00±0.50^abc	1.08±0.49^abc	14.80±2.71^ac
F值	154.630	240.545	412.905
P值	＜0.001	＜0.001	＜0.001
注：与术前比较，^aP＜0.05；与术后3 d比较，^bP＜0.05，与术后3个月比较，^cP＜0.05。

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