毛文琪　杨勇　熊朝霞

[關键词] 腰椎间盘突出症;脊柱内镜;外科化理念;腰椎功能

[中图分类号] R681.5          [文献标识码] B          [文章编号] 1673-9701（2021）14-0088-04

Application of the surgical concept of spinal endoscopy in lumbar degenerative diseases

MAO Wenqi   YANG Yong   XIONG Zhaoxia

Department of Orthopedics， Xinyu People's Hospital in Jiangxi Province， Xinyu   338025， China

[Abstract] Objective To investigate the clinical effect of the surgical concept of spinal endoscopy in the treatment of lumbar disc herniation. Methods From January 2018 to August 2019， a total of 120 cases of lumbar disc herniation with typical nerve root compression symptoms treated in our hospital were retrospectively analyzed， all of which were single-segment lesions. 60 cases underwent endoscopic spinal surgery based on the surgical concept （the incision length of the surgical concept group）. 60 cases were treated with ordinary spinal endoscopic nucleus pulposus（the ordinary endoscopy group）. The surgical indicators of the two groups were observed， including operation time， intraoperative blood loss， postoperative hospital stay. The VAS scores of the affected limbs and the oswestry disability index（ODI） at one month， three months， six months， and one year after operation were compared between the two groups. Results The operations were successfully completed. The blood loss and postoperative hospital stay of the surgical concept group was significantly less than that of the ordinary endoscopy group（P<0.05）. The operation time of the surgical concept group was significantly higher than that of the ordinary endoscopy group（P<0.05）. There were no significant differences in VAS score of lower limb pain and the Oswestry dysfunction index between the two groups at one month and three months after surgery（P>0.05）. The VAS score in the surgical concept group at six months after the operation （1.4±0.3） and one year after the operation （1.5±0.4） was significantly lower than those in the ordinary endoscopy group， and the difference between the two groups was statistically significant（P<0.05）. The ODI score at six months after the operation（13.7±4.8） and one year after the operation （13.5±4.6） in the surgical concept group were significantly lower than those in the ordinary endoscopy group. The difference between the two groups was statistically significant（P<0.05）. Conclusion The surgical concept of spinal endoscopy is a safe and effective method to treat lumbar disc herniation， which has better mid- and long-term results than ordinary spinal endoscopic nucleus extraction.

[Key words] Lumbar intervertebral disc herniation; Spinal endoscopy; Surgical concept; Lumbar spine function

腰椎间盘突出导致的腰腿痛是骨科最常见的临床病症。临床上除外影像学明确提示有髓核导致神经根受压的情况可以引起腰背痛及下肢痛，也可因关节突关节增生，黄韧带肥厚、侧隐窝狭窄等原因导致神经根逃逸空间减小而引起临床症状。外科手段中，髓核摘除术是治疗腰椎间盘突出症的有效方法[1]，能够直接摘除突出的髓核组织，解除神经组织的压迫。经皮侧路脊柱内镜技术是目前国内最为微创，且安全有效的髓核摘除技术，其优点显而易见，手术切口小，经椎间孔进入椎管，靶向摘除突出的髓核组织，无需剥离腰椎后方肌肉，不损伤腰椎后方重要的骨关节及韧带，对腰椎的稳定性没有明显的破坏[2-3]。但是随着该技术的广泛应用，病例数的不断增加，随访时间的延长，逐渐暴露出症状残留、复发等棘手问题，所以迫切需要改进手术技术以获得更好的临床效果[4]。

1 资料与方法

1.1 一般资料

选取2018年1月至2019年8月腰椎间盘突出症患者120例。男67例，女53例;年龄23～75岁;腰2～3间隙3例，腰3～4间隙13例，腰4～5间隙61例，腰5～骶1间隙43例。随机分为外科理念组与普通内镜组，每组各60例。两组患者一般临床资料比较，差异无统计学意义（P>0.05），具有可比性。

纳入标准[5]：①单节段突出，诊断明确;②腰部疼痛VAS评分<4分;③保守治疗3个月无效或再发者。

排除标准[6]：①神经定位不明确的患者;②基础疾病严重不能耐受手术者;③凝血功能障碍者;④患者神经根性疼痛VAS评分小于4分者。