经椎间孔内窥镜腰椎间盘切除术与显微椎间盘切除术的临床和影像学效果比较:超过五年的随访。

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY
Neurospine Pub Date : 2024-03-01 Epub Date: 2024-02-01 DOI:10.14245/ns.2347026.513
Xinyu Yang, Shijun Zhang, Junxiao Su, Sai Guo, Yakubu Ibrahim, Kai Zhang, Yonghao Tian, Lianlei Wang, Suomao Yuan, Xinyu Liu
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引用次数: 0

摘要

目的:比较经椎间孔内窥镜腰椎间盘切除术(TELD)与显微椎间盘切除术(MD)的长期临床和影像学疗效:回顾性分析了154名腰椎间盘突出症(LDH)患者的数据,这些患者接受了TELD(89人)或MD(65人)手术。采用腿部和腰部疼痛视觉模拟量表、日本骨科协会(JOA)评分和奥斯韦特里残疾指数(ODI)对患者的临床结果进行了评估。随访期间还观察了放射学表现的变化。研究还调查了临床效果不佳的潜在风险因素:在平均 5.5 年(5-7 年)的随访期间,TELD 组的复发率为 4.49%,MD 组为 1.54%。两组患者的所有评分从术前到术后均有明显改善(p 结论:TELD 和 MD 均可为 LDH 患者提供令人满意的长期临床疗效。TELD 可作为 MD 的可靠替代方案,手术创伤较小。莫迪II型改变、术前椎间高度降低和高体重指数是预后不良的预测因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years.

Objective: To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD).

Methods: The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients' clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated.

Results: During a mean follow-up of 5.5 years (range, 5-7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio.

Conclusion: Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.

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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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