The Journal of Practical Medicine >

2024 , Vol. 40 >Issue 12: 1690 - 1695

DOI: https://doi.org/10.3969/j.issn.1006-5725.2024.12.013

Clinical Research

Effect of percutaneous endoscopic foraminal discectomy on clinical outcome of L5⁃S1 lumbar disc herniation and influence of iliac crest height on clinical efficacy

  • Deta CHEN ,
  • Xinhua ZHAN ,
  • Xiaoping SHENG ,
  • Wu RAO ,
  • Jingliang GU ,
  • Yan YU
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  • Shanghai Municipal Hospital of Traditional Chinese Medicine，Shanghai University of Traditional Chinese Medicine，Shanghai 200071，China

Received date: 2023-09-22

  Online published: 2024-06-14

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Abstract

Objective To investigate the effect of percutaneous endoscopic transforaminal discectomy （PETD） on L5-S1 lumbar disc herniation （LDH） and the influence of iliac crest height on the clinical efficacy. Methods A total of 86 patients treated with PETD for LDH （L5-S1 segment） from February 2019 to February 2018 were selected and grouped according to the relationship between the highest point of the iliac crest and the position of the L4-5 pedicle. Forty-eighty patients with the highest point of the iliac crest located below the upper edge of the L5 pedicle were included in group A； thirty-three patients with the highest point of the iliac crest located between the lower edge of the L4 pedicle and the upper edge of the L5 pedicle were included in group B， and five patients with the highest point of the iliac crest located above the lower edge of the L4 pedicle were included in group C. The operation indexes of the three groups were compared. The visual analogue score （VAS） and Oswestry Disability index （ODI） before and after surgery ［preoperative（T0）， 1 week after surgery （T1）， 1 month， 6 months and 12 months after surgery （T2，T3，T4）］were compared among the three groups. Results There was no difference in operation time and blood loss among the three groups （P > 0.05）. At T0， there was no difference in VAS score and ODI among the three groups （P > 0.05）. At T1-T4， when VAS score and ODI of the three groups were lower than that at T0， VAS in group A and B was lower than that in group C （P < 0.05）， but there was no difference between group A and B （P > 0.05）. Conclusion PETD has significantly clinical efficacy in the treatment of L5-S1 LDH， and whether the iliac crest height is higher than the level of the lower edge of the L4 pedicle will affect its clinical efficacy.

Key words： percutaneous endoscopic transforaminal discectomy; L5-S1; lumbar disc herniation; iliac crest height; clinical effect

Cite this article

Deta CHEN , Xinhua ZHAN , Xiaoping SHENG , Wu RAO , Jingliang GU , Yan YU . Effect of percutaneous endoscopic foraminal discectomy on clinical outcome of L5⁃S1 lumbar disc herniation and influence of iliac crest height on clinical efficacy[J]. The Journal of Practical Medicine, 2024 , 40(12) : 1690 -1695 . DOI: 10.3969/j.issn.1006-5725.2024.12.013

References

1 Basic Research and Transformation Society，Professional Committee of Spine and Spinal Cord，Chinese Association of Rehabilitation Medicine. ［Guideline for diagnosis， treatment and rehabilitation of lumbar disc herniation］［J］. Zhonghua Wai Ke Za Zhi， 2022， 60（5）：401-408.
2 XU J， DING X， WU J， et al. A randomized controlled study for the treatment of middle-aged and old-aged lumbar disc herniation by Shis spine balance manipulation combined with bone and muscle guidance［J］. Medicine （Baltimore）， 2020，99（51）：e23812. doi:10.1097/md.0000000000023812
3 ZHANG A S， XU A， ANSARI K， et al. Lumbar Disc Herniation： Diagnosis and Management［J］. Am J Med， 2023， 136（7）：645-651. doi:10.1016/j.amjmed.2023.03.024
4 WANG L， HE T， LIU J， et al. Revealing the Immune Infiltration Landscape and Identifying Diagnostic Biomarkers for Lumbar Disc Herniation［J］. Front Immunol， 2021， 12：666355. doi:10.3389/fimmu.2021.666355
5 陈齐齐，陈立平，金军，等. 多裂肌横截面积与经皮椎间孔镜治疗腰椎间盘突出症患者预后的关系［J］. 实用医学杂志， 2021，37（9）：1136-1140. doi:10.3969/j.issn.1006-5725.2021.09.008
6 胡民结，胡旭琪，潘学康，等.老年腰椎间盘突出症患者经皮椎间孔镜下微创技术治疗后恢复状态的影响因素［J］.广东医学， 2022，43（10）：1291-1295.
7 GADJRADJ P S， HARHANGI B S， AMELINK J， et al. Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation： A Systematic Review and Meta-analysis［J］. Spine （Phila Pa 1976）， 2021， 46（8）：538-549. doi:10.1097/brs.0000000000003843
8 刘奋飞.体质量指数与经皮椎间孔入路内窥镜下椎间盘切除术治疗腰椎间盘突出症患者的早期疗效关系研究［J］.颈腰痛杂志， 2021，42（1）：36-40. doi:10.3969/j.issn.1005-7234.2021.01.008
9 中华医学会骨科学分会脊柱外科学组，中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南［J］.中华骨科杂志， 2020，40（8）：477-487. doi:10.3760/cma.j.cn121113-20200402-00213
10 曹卉娟，邢建民，刘建平. 视觉模拟评分法在症状类结局评价测量中的应用［J］. 中医杂志， 2009，50（7）：600-602. doi:10.3321/j.issn:1001-1668.2009.07.009
11 俞红，白跃宏. 简式中文版Oswestry功能障碍指数评定下背痛患者的信度及效度分析［J］. 中华物理医学与康复杂志， 2010，32（2）：125-127. doi:10.3760/cma.j.issn.0254-1424.2010.02.012
12 SHEN S C， CHEN H C， TSOU H K， et al. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation based on image analysis and clinical findings： A retrospective review of 345 cases［J］. Medicine （Baltimore）， 2023，102（5）：e32832. doi:10.1097/md.0000000000032832
13 ZHU K， HE D. Transforaminal percutaneous endoscopic discectomy for symptomatic gas-filled discal cysts-report of three cases and literature review［J］. J Orthop Surg Res， 2021， 16（1）：251. doi:10.1186/s13018-021-02403-8
14 FAN N， YUAN S， DU P， et al. Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis［J］. BMC Musculoskelet Disord， 2021， 22（1）：1041. doi:10.1186/s12891-021-04940-z
15 董建国，刘广辉.椎板间入路经皮内镜下腰椎间盘切除术治疗L5-S1腰椎间盘突出症的临床疗效及患者术后再手术的危险因素分析［J］. 颈腰痛杂志， 2021，42（3）：346-348.
16 ZHANG J， GAO Y， ZHAO B， et al. Comparison of percutaneous transforaminal endoscopic discectomy and open lumbar discectomy for lumbar disc herniations： A systematic review and meta-analysis［J］. Front Surg， 2022， 9： 984868. doi:10.3389/fsurg.2022.984868
17 范明星，房彦名，安岩，等.机器人辅助L4、L5椎弓根螺钉内固定术治疗腰椎滑脱症的学习曲线研究［J］.中华骨科杂志，2022，42（6）：341-348. doi:10.3760/cma.j.cn121113-20211103-00635
18 赵建娜，高天翔，张晓明. L4-5、L5-S1椎间盘突出青年患者椎体小关节角度及接触直径观察［J］. 山东医药，2022，62（3）：85-87. doi:10.3969/j.issn.1002-266X.2022.03.021
19 MAO L， WANG K， HUANG Y， et al. Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests［J］. Orthop Surg， 2022，4（8）：1715-1722. doi:10.1111/os.13355
20 KAPETANAKIS S， GKANTSINIKOUDIS N， CHARITOUDIS G. Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation： Original Study and Review of the Literature［J］. Am J Sports Med， 2021，49（12）：3234-3241. doi:10.1177/03635465211032612
21 ZHOU Z， NI H J， ZHAO W， et al. Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two-Level Disc Herniation［J］. Orthop Surg， 2021， 13（3）：979-988. doi:10.1111/os.12862
22 YU C， ZHAN X， LIU C， et al. Risk Factors for Recurrent L5-S1 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy： A Retrospective Study［J］. Med Sci Monit， 2020， 26：e919888. doi:10.12659/msm.919888
23 李鹏，张淋霖. 不同入路经皮内镜腰椎间盘切除术治疗高髂嵴连线L5-S1腰椎间盘突出症的效果及对MRI定量参数、腰椎生物力学的影响［J］. 临床医学研究与实践， 2022，7（35）：69-72，135.
24 黄钿锋， 林龙泉， 曹杰， 等. 髂嵴高度对经皮脊柱内镜椎间孔入路腰椎间盘切除术治疗L5-S1腰椎间盘突出症的临床影响［J］. 联勤军事医学， 2023， 37（5）： 395-399.
25 陈诚，卢洋，陈晓庆.基于CT扫描及三维重建评估髂嵴对L5/S1经椎间孔穿刺置管的影响［J］.西安交通大学学报（医学版），2022，43（1）：138-142.
26 高航飞，桂鉴超，蒋逸秋，等. 髂棘高度量化指标对L5、S1、椎间盘突出经皮椎间孔镜入路影响的研究［J］. 中国修复重建外科杂志， 2020，34（2）：157-161.
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