目的

评估显微镜辅助微创经椎间孔入路腰椎椎间融合术治疗复发性腰椎间盘突出症（RLDH）的安全性及治疗效果。

方法

回顾性分析邯郸邯钢医院2021 年4 月至2023 年3 月收治的经皮内镜下腰椎间盘摘除术（PELD）后复发的腰椎间盘突出症患者37 例，25 例采用微创经椎间孔入路腰椎椎间融合术，男性12 例，女性13 例，年龄（50.4±4.1）岁，12 例采用显微镜辅助微创经椎间孔入路腰椎椎间融合术，男性5 例，女性7 例，年龄（50.3±5.0）岁。比较2 组患者手术时间、术中出血量、切口长度、术后引流量、住院时间及早期并发症；术前、术后3 月、术后6 月及末次随访时腰腿疼痛视觉模拟VAS 评分、Oswestry 功能障碍指数ODI 指数，术后1 年Bridwell 椎间融合评分。

结果

所有患者手术顺利。显微镜组手术时间（170.9±8.6）min，术中出血量（137.8±7.4）ml，术后引流量（87.8±9.3）ml，术后住院时间（6.7±1.1）d，术中出现脑脊液漏1 例，术后未出现神经损伤症状及伤口浅部感染；常规组手术时间（166.6±8.9）min，出血量（141.3±6.6）ml，术后引流量（90.4±12.9）ml，术后住院时（7.0±1.1）d，术中出现脑脊液漏1 例，术后出现神经损伤症状1 例，未出现伤口浅部感染。2 组患者围手术期及并发症相关数据均无统计学差异（P>0.05）。2 组腰椎融合结果差异无统计学意义（P>0.05）。

结论

显微镜辅助微创经椎间孔入路腰椎椎间融合术作为翻修术治疗RLDH 安全有效并且具有术野清晰、方便教学等优点，值得临床推广应用。

Objective

To evaluate the safety and therapeutic effectiveness of microscope-assisted minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for treating recurrent lumbar disc herniation (RLDH).

Methods

A retrospective analysis was conducted on 37 patients with recurrent lumbar disc herniation following percutaneous transforaminal endoscopic lumbar discectomy (PELD) treated at Handan Steel Hospital from April 2021 to March 2023. Of these patients, 25 underwent minimally invasive transforaminal lumbar interbody fusion,including 12 males and 13 females, with an average age of (50.4±4.1)years. Another 12 patients underwent microscope-assisted MIS-TLIF, including 5 males and 7 females,with an average age of (50.3±5.0) years. Comparisons were made between the two groups regarding operative time, intraoperative blood loss, incision length, postoperative drainage, hospital stay, and early complications. Preoperative, postoperative 3-month, postoperative 6-month, and last follow-up evaluations included the Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and 1-year postoperative Bridwell fusion grading.

Results

All surgeries were successfully completed. The microscope group had an average operative time of (170.9±8.6) minutes, intraoperative blood loss of (137.8±7.4) ml,postoperative drainage of (87.8±9.3) ml, and postoperative hospital stay of (6.7±1.1) days.There was one case of cerebrospinal fluid leakage during surgery in this group, but no postoperative neurological damage or superficial wound infections were observed. The conventional group had an average operative time of (166.6±8.9) minutes, blood loss of (141.3±6.6) ml, postoperative drainage of (90.4±12.9) ml, and postoperative hospital stay of (7.0±1.1) days, with one case each of intraoperative cerebrospinal fluid leakage and postoperative neurological damage, but no superficial wound infections. There were no statistically significant differences in perioperative and complication-related data between the two groups (P<0.05).There was also no statistically significant difference in lumbar fusion outcomes between the groups (P<0.05).

Conclusion

Microscope-assisted MIS-TLIF as a revision surgery for RLDH is safe and effective, offering clear surgical fields and ease of teaching, which is advantageous and warrant broader clinical application.