微创医学

目的探讨经皮椎间孔镜联合可视化环锯椎间孔成形术治疗高髂脊人群腰5/骶1（L5/S1）椎间盘突出症的临床效果。方法选取接受可视化环锯椎间孔成形术经皮椎间孔入路椎间孔镜L5/S1椎间盘切除的100例患者，按是否存在高髂嵴把患者分为观察组（n=50）和对照组（n=50）。比较两组患者手术时间、术中透视次数、术中出血量、住院时长和住院费用、腿痛的视觉模拟疼痛（VAS）评分、Oswestry功能障碍指数（ODI）及术后并发症发生率。结果观察组患者的手术时间、术中透视次数、术中出血量均明显多于对照组，差异均有统计学意义（均P＜0.05）；两组患者的住院时间、住院费用比较，差异均无统计学意义（P＞0.05）。术前，两组患者的VAS评分比较，差异无统计学意义（P＞0.05）；术后1个月、3个月、6个月、12个月，两组患者的VAS评分、ODI评分均低于术前，而观察组上述各时点的VAS评分、ODI评分与对照组比较，差异均有统计学意义（均P＜0.05）。两组患者术后并发症发生率（14.0% vs. 6.0%）比较，差异无统计学意义（P＞0.05）。结论可视化环锯椎间孔成形术可有效而安全地应用于经皮经椎间孔入路椎间孔镜L5/S1椎间盘切除，但高髂嵴可导致手术时间、术中透视次数和术中出血量增加，仍为影响手术的不利因素。

Objective To investigate the clinical effect of percutaneous transforaminal endoscopy combined with visual trephine foraminoplasty for lumbar L5/S1 disc herniation in patients with high iliac crest. Methods A total of 100 patients who underwent percutaneous transforaminal endoscopic L5/S1 discectomy with visual trephine foraminoplasty were selected. The patients were divided into observation group (n=50) and control group (n=50) according to the presence or absence of high iliac crest. The operation time, intraoperative fluoroscopy times, intraoperative blood loss, length and cost of hospitalization, visual analogue scale (VAS) score of leg pain, Oswestry disability index (ODI) and incidence of postoperative complications were compared between the two groups. Results The operation time, intraoperative fluoroscopy times, and intraoperative blood loss in the observation group were significantly more than those in the control group, and the differences were statistically significant (all P＜0.05). There was no statistically statistically significant difference in the length and cost of hospitalization between the two groups (P＞0.05). There was no statistically significant difference in VAS score between the two groups before operation (P＞0.05). At 1 month, 3 months, 6 months and 12 months after operation, the VAS score and ODI score of the two groups were lower than those before operation, while the VAS score and ODI score of the observation group at each time point were significantly different from those of the control group (all P＜0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (14.0% vs. 6.0%) (P＞0.05). Conclusion Percutaneous transforaminal endoscopic L5/S1 discectomy can be performed safely and effectively by using the visual trephine foraminoplasty technique. However, the high iliac crest can lead to the increase of operation time, intraoperative fluoroscopy times and intraoperative blood loss, which is still an unfavorable factor affecting the operation.