| Objective: To study the safety and short-term clinical efficacy of nucleus pulposus extirpation combined with annulus fibrosus suture via the Vista channel system in the treatment of single-segment lumbar disc herniation.Methods: A total of 112 patients with lumbar disc herniation who treat with nucleus pulposus extirpation in Department of Spine surgery,First Affiliated Hospital of Guangxi Medical University from January 2017 to April 2020,who met the inclusion and exclusion criteria,were followed up and analyzed.There were 83 males and 29 females,with a mean age of 32.05 years(18-55 years).This study included 53 cases of nucleus pulposus extirpation combined with annulus fibrosus suture via the Vista channel system as group A,and 59 cases of lamina decompression and nucleus pulposus extirpation as group B.The surgical section,age,body mass index(BMI),herniated type and other risk factors were collected.The operation time,intraoperative blood loss,and size of surgical incision were recorded.Pain visual analog scores(VAS)and Oswestry dysfunction index(ODI)were used to evaluate functional recovery.At the last follow-up,the overall efficacy were evaluated by Macnab evaluation criteria.Before and after the operation,the height of the intervertebral space was measured on X-ray lateral film.Results: The mean follow-up of all cases is 28.71 months(12-51 months).Before the operation,the two groups were similar in VAS score,ODI index,age,gender,body mass index herniated type and height of the intervertebral space of the operation segment.Operation time: group A(106.62±35.32 min)> group B(76.61±45.09 min),incision length: group A(2.49±0.54 cm)< group B(3.42±0.75 cm),blood loss: group A(60.75 ±29.34)< group B(101.53±23.40ml),the above difference is statistically significant(P<0.05).The height of the intervertebral space of the operative segment: in group A pre-operation(11.34±1.99 mm),post-operation(10.59±1.79 mm),decreased value(0.75±0.76mm),the height reduced by 6.61%,in group B before pre-operation(11.08±1.68mm),post-operation(9.84±1.75 mm),decrease value(1.24±0.74 mm),and the height reduced by 11.19%,the difference of decrease value in the two groups was statistically significant(P<0.05).VAS score and ODI score: in group A pre-operation(8.15±0.91),(71.22±5.76),1 year after operation(0.89±0.53),(4.04±0.98);in group B pre-operation(8.22±0.81),(71.16)±4.78),1 year after operation(1.39±0.45),(4.57±0.97),the differences of above score was statistically significant(P<0.05).The outcomes of last follow-up were evaluated by Mac Nab evaluation criteria.In group A,the curative effect was rated as excellent,good,fair and poor in 35 cases,13 cases,2 cases and 3 cases,respectively.And in group B,the above data were 27 cases,24 cases,3 cases,and 5 cases,respectively.The difference in effect composition ratio between the two groups was statistically significant(P<0.05).In group A,there were 3 cases(5.66%)of relapse,3 cases(5.66%)of reoperation and 1 case(1.89%)of wound infection occurred.In group B,there were 5 cases(8.47%)of relapse,3 cases(5.08%)of reoperation,2 cases(3.39%)of wound infection and 1 case(1.69%)of postoperative epidural cyst.The two group shows no significant difference in recurrence rate and reoperation rate((P>0.05).Conclusion: 1.In the treatment of single-segment LDH,both nucleus pulposus extirpation combined with annulus fibrosus suture via the Vista channel system and laminectomy nucleus pulposus extirpation have achieved satisfactory results.The former has advantages in postoperative recovery,which proves that nucleus pulposus extirpation combined with annulus fibrosus suture via the Vista channel system is safe,effective and worthy promoting;2.Compared with lamina decompression and nucleus pulposus extirpation,patients who received nucleus pulposus combined with annulus fibrosus suture have better retention of the disc height,which may be beneficial maintain the biomechanical function of the intervertebral disc after surgery and reduce recurrence. |
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