【摘要】 目的:探讨经皮内窥镜下腰椎间盘切除术中椎间孔成形的适应证。方法:选取经椎间孔入路行经皮内窥镜下腰椎间盘切除术的单节段腰椎间盘突出症患者,其中36例患者术中进行了椎间孔成形(椎间孔成形组),50例患者术中未进行椎间孔成形(椎间孔未成形组)。在患者术前的CT图像上测定病变节段的椎间隙高度、椎间孔宽度、椎板角,在术前X线片上测定患者的髂嵴高度,在术前MRI上测定突出椎间盘的下移程度。结果:椎间孔成形组椎间隙高度低于椎间孔未成形组[(5.92±1.22)mm,(6.74±0.92)mm,t=-3.555,P=0.004],突出椎间盘向下重度移位者所占比例高于椎间孔未成形组(P=0.031);2组患者的椎间孔宽度、椎板角及髂嵴高度比较,组间差异均无统计学意义[(6.92±1.03)mm,(7.07±1.20)mm,t=-0.606,P=0.566;99.52°±10.62°,98.23°±8.77°,t=0.616,P=0.739;(33.38±1.06)mm,(32.69±2.24)mm,t=1.713,P=0.164]。L5S1腰椎间盘突出症患者中,椎间孔成形组的椎间隙高度、椎间孔宽度均小于椎间孔未成形组[(4.13±1.22)mm,(5.19±0.92)mm,t=-3.198,P=0.006;(5.89±1.38)mm,(7.28±1.28)mm,t=-3.387,P=0.002],髂嵴高度大于椎间孔未成形组[(35.26±3.44)mm,(32.78±2.86)mm,t=2.549,P=0.001];2组患者的椎板角、突出椎间盘下移程度比较,组间差异均无统计学意义(96.52°±8.62°,95.23°±6.77°,t=0.542,P=0.173;P=0.476)。中央型腰椎间盘突出症患者中,椎间孔成形组的椎间隙高度小于椎间孔未成形组[(5.66±0.75)mm,(6.93±0.92)mm,t=-3.499,P=0.006],椎板角大于椎间孔未成形组(103.58°±5.32°,92.38°±4.37°,t=5.426,P=0.001);2组患者的椎间孔宽度、髂嵴高度、突出椎间盘下移程度比较,组间差异均无统计学意义[(5.86±1.46)mm,(7.18±1.41)mm,t=-2.152,P=0.472;(33.25±2.01)mm,(34.03±1.63)mm,t=0.289,P=0.775;P=0.455]。结论:病变节段椎间隙狭窄的腰椎间盘突出症、突出物向下移位严重的腰椎间盘突出症、髂嵴较高的L5S1椎间盘突出症、病变节段椎板角较大的中央型腰椎间盘突出症,均应视为经皮内窥镜下腰椎间盘切除术中椎间孔成形的适应证。更多还原

【Abstract】 Objective: To explore the indications of foraminoplasty in percutaneous endoscopic lumbar discectomy( PELD). Methods:Eighty-six patients with single-segment lumbar disc herniation( LDH) who received PELD through intervertebral foramina approach were selected. The foraminoplasty was performed on 36 patients( foraminoplasty group) and was not performed on 50 patients( non-foraminoplasty group) during the PELD. The intervertebral space height,the intervertebral foramina width and the vertebral plate angle of diseased segment were measured on patients’ preoperative CT images. The iliac crest height and the downward-displacement degree of herniated intervertebral disc were measured on patients’ preoperative CT images and preoperative MRI respectively. Results: The intervertebral space heights were lower,and the proportion of patients with severe downward-displacement of herniated intervertebral discs was higher in foraminoplasty group compared to non-foraminoplasty group( 5. 92 +/-1. 22 vs 6. 74 +/-0. 92 mm,t =-3. 555,P = 0. 004; P = 0. 031).There was no statistical difference in intervertebral foramina width,vertebral plate angle and iliac crest height between foraminoplasty group and non-foraminoplasty group( 6. 92 +/-1. 03 vs 7. 07 +/-1. 20 mm,t =-0. 606,P = 0. 566; 99. 52 +/-10. 62 vs 98. 23 +/-8. 77 degrees,t = 0. 616,P = 0. 739; 33. 38 +/-1. 06 vs 32. 69 +/-2. 24 mm,t = 1. 713,P = 0. 164). For patients with L5-S1 LDH,the intervertebral space heights and the intervertebral foramina widths were smaller and the iliac crest heights were greater in foraminoplasty group compared to non-foraminoplasty group( 4. 13 +/-1. 22 vs 5. 19 +/-0. 92 mm,t =-3. 198,P = 0. 006; 5. 89 +/-1. 38 vs 7. 28 +/-1. 28 mm,t =-3. 387,P = 0. 002; 35. 26 +/-3. 44 vs 32. 78 +/-2. 86 mm,t = 2. 549,P = 0. 001),while there was no statistical difference in vertebral plate angle and downward-displacement degree of herniated intervertebral discs between foraminoplasty group and non-foraminoplasty group( 96. 52 +/-8. 62 vs 95. 23 +/-6. 77 degrees,t = 0. 542,P = 0. 173; P = 0. 476). For patients with central-type LDH,the intervertebral space heights were smaller and the vertebral plate angles were larger in foraminoplasty group compared to non-foraminoplasty group( 5. 66 +/-0. 75 vs 6. 93 +/-0. 92 mm,t =-3. 499,P = 0. 006; 103. 58 +/-5. 32 vs 92. 38 +/-4. 37 degrees,t = 5. 426,P = 0. 001),while there was no statistical difference in intervertebral foramina width,iliac crest height and downward-displacement degree of herniated intervertebral discs between foraminoplasty group and non-foraminoplasty group( 5. 86 +/-1. 46 vs 7. 18 +/-1. 41 mm,t =-2. 152,P =0. 472; 33. 25 +/-2. 01 vs 34. 03 +/-1. 63 mm,t = 0. 289,P = 0. 775; P = 0. 455). Conclusion: LDH with narrow intervertebral space at diseased segment,LDH with severe downward displacement of herniated disc,L5-S1 LDH with high iliac crest and central-type LDH with large vertebral plate angle at diseased segment should be regarded as the indications of foraminoplasty in PELD.更多还原