Application of microendoscopic discectomy associated with annulus fibrosus repair in prolapse of lumbar intervertebral disc
LI Dong CHANG Zhiyong CHEN Gang LI Kaihua
Department of Orthopaedics, Jiangsu Province Hospital of Traditional Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province, Nanjing 210029, China
Abstract：Objective To investigate the application effect of microendoscopic discectomy associated with annulus repair in patients with single segment of prolapse of lumbar intervertebral disc. Methods The clinical data of 19 cases of patients with prolapse of lumbar intervertebral disc underwent microendoscopic discectomy associated with annulus fibrosus repair treated in Jiangsu Province Hospital of Traditional Chinese Medicine from May 2014 to December 2015 was analyzed retrospectively. The postoperative effects were evaluated by visual analogue score (VAS), Oswestry disability index (ODI) and MacNab standard. Results All patients completed the follow-up, and the mean follow-up was (27.30±5.24) months (18-37 months). No recurrence was found in 19 cases. The scores of VAS before operation, after operation for 3 months, after operation for 1 year and at the final follow-up were (7.11±0.86), (1.58±1.03), (1.37±0.81), (1.26±0.73) scores respectively. The scores of each postoperative time point were all lower than those before operation, with highly statistically significant differences (all P ＜ 0.01). The ODI before operation, after operation for 3 months, after operation for 1 year and at the final follow-up were (63.73±10.86)%, (22.26±7.58)%, (16.47±3.34)% and (14.21±3.67)% respectively. The scores of each postoperative time points were all lower than those before operation, with highly statistically significant differences (all P ＜ 0.01). Short term clinical efficacy was evaluated by MacNab standard: 14 cases were excellent, 4 cases were good and 1 case was better. The excellent and good rate was 94.7%. Conclusion Microendoscopic discectomy associated with annulus fibrosus repair is an effective mini-invasive therapy for the treatment of single segment of prolapse of lumbar intervertebral disc. Controlling the indications strictly is helpful to achieve the satisfactory curative effect and low recurrence rate.
[1] Hayes MHS，Paterson DG. Experimental development of the graphic rating method [J]. Psychol Bull，1921，18：98-99.
[2] Fairbank JC，Couper J，Davies JB，et al. The Oswestry low back pain questionnaire [J]. Physiotherapy，1980，66（8）：271-273.
[3] Macnab I. Negative disc exploration：an analysis of the causes of nerve-root involvement in sixty-eight patients [J]. J Bone Joint Surg Am，1971，53（5）：891-903.
[4] 李东，陈刚，李开华.椎间盘镜治疗腰椎间盘突出症的中期疗效观察[J].中国骨与关节杂志，2016，5（5）：371-374.
[5] 郭二鹏，李宽新，李建柱.后路显微椎间盘镜与传统开窗手术治疗腰椎间盘突出症的Meta分析[J].重庆医学，2015， 44（21）：2935-2943.
[6] Hussein M，Abdeldayem A，Mattar MM. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations：a prospective，randomized，controlled study with 8 years of follow-up [J]. Eur Spine J，2014，23（9）：1992-1999.
[7] Ambrossi GL，McGirt MJ，Sciubba DM，et al. Recurrent lumbar disc herniation after single-level lumbar discectomy：incidence and health care cost analysis [J]. Neurosurgery，2009，65（3）：574-578.
[8] Leven D，Passias PG，Errico TJ，et al. Risk factors for reoperation in patients treated surgically for intervertebral disc herniation：a subanalysis of eight-year SPORT date [J]. J Bone Joint Surg Am，2015，97（16）：1316-1325.
[9] Miwa S，Yokogawa A，Kobayashi T，et al. Risk factors of recurrent lumbar disc herniation：a single center study and review of the literature [J]. J Spinal Disord Tech，2013，28（5）：E265-E269.
[10] Matsumoto M，Watanabe K，Hosogane N，et al. Recurrence of lumbar disc herniation after microendoscopic discectomy [J]. J Neurol Surg，2013，74（4）：222-227.
[11] Huang WM，Han ZW，Liu J，et al. Risk factors for recurrent lumber disc herniation：a systematic review and meta-analysis [J]. Medicine（Baltimore），2016，95（2）：e2378.
[12] 刘军，张陆，姜岩，等.两种手术方式治疗高位腰椎间盘突出症的临床疗效[J].中国现代医生，2016，54（5）：66-69.
[13] 胡袒，郑超，伍骥，等.内窥镜下椎间盘切除术治疗腰椎间盘突出症术后复发的影响因素分析[J].中国脊柱脊髓杂志，2015，25（10）：899-903.
[14] Bailey A，Araghi A，Blumenthal S，et al. Prospective，multicenter，randomized，controlled study of anular repair in lumbar discectomy [J]. Spine（Phila Pa 1976），2013，38（14）：1161-1169.
[15] Parker SL，Grahovac G，Vukas D，et al. Effect of an Annular Closure Device（Barricaid）on Same-Level Recurrent Disk Herniation and Disk Height Loss After Primary Lumbar Discectomy：Two year Results of a Multicenter Prospective Cohort Study [J]. Clin Spine Surg，2016，29（10）：454-460.
[16] Suh BG，Uh JH，Park SH，et al. Repair using conventional implant for ruptured annulus fibrosus after lumbar discectomy：surgical technique and case series [J]. Asian Spine Journal，2015，9（1）：14-21.
[17] Yang CH，Chiang YF，Chen CH，et al. The effect of annular repair on the failure strength of the porcine lumbar disc after needle puncture and punch injury [J]. Eur Spine J，2016，25（3）：906-912.
[18] 李传将，黎庆初，王小勇，等.纤维环修复同步行内镜下腰椎间盘摘除：早期腰椎功能恢复比较[J].中国组织工程研究，2014，18（46）：7386-7390.
[19] 牛玉珍，李功伟，杨吉风.显微内镜腰椎间盘摘除术下纤维环缝合治疗腰椎间盘突出症疗效观察[J].山西医药杂志，2015，11（44）：1295-1296.
[20] 郭新军，朱卉敏，王衡，等.一次性纤维环缝合器在腰椎间盘突出症髓核摘除术中的应用[J].中医正骨，2015， 27（3）：59-63.
[21] 朱召银，黎庆初，杨洋，等.显微内窥镜下髓核摘除纤维环缝合治疗腰椎间盘突出症的疗效分析[J].中国脊柱脊髓杂志，2017，27（3）：213-219.
2017, Vol. 14 
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