脊柱骨盆矢状面形态与腰椎间盘突出症经椎间孔镜术后复发关系研究

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Abstract Objective To explore the key parameters of the sagittal plane of the spinal pelvis after transforaminal endoscopic discectomy in treatment of patients with lumbar disc herniation and clarify the relationship between different Roussouly classifications of the lumbar and recurrence of transforaminal endoscopic discectomy in treatment of patients with lumbar disc herniation.Methods The data of patients with lumbar disc herniation treated by transforaminal endoscopic discectomy from January 2015 to December 2019 were retrospectively analyzed.The patients of recurrence were included in the experimental group(32 cases)，among them，there were 18 males and 14 females.The patients were 36~51 years old with an average age of(41.2±9.8).There were 21 cases of L_4～5 and 11 cases of L₅S₁.Randomly selected patients without recurrence after operation were included in a control group(32 cases).Among them，there were 17 males and 15 females.The patients were 35~54 years old with an average age of(46.3±10.6).There were 21 cases of L_4～5，11 cases of L₅S₁.In standing position on the whole spine before operation，divide the sagittal curve of the lumbar spine into four types according to the position of the apex of the lumbar spine(Roussouly classification).Type Ⅰ：the apex is in the L₅ vertebral body or L_4～5 intervertebral space.Type Ⅱ：the apex is at the bottom or middle of L₄.Type Ⅲ：the apex is in the upper L₄ or L_3～4 intervertebral space.Type Ⅳ：the apex is located at and above the L₃ vertebral body.The lumbar lordosis angle(LL)，pelvic incidence angle(PI)，pelvic tilt angle(PT)，and sacral tilt angle(SS) were measured，compare the imaging index and Roussouly classification between the two groups.Results Experimental group PI was (31.5±3.3)°，PT was (11.7±2.7)°，SS was (25.1±4.2)° and LL was (31.6±2.5)°，all were significantly lower than the control group (44.0±5.6)°，(15.1±3.8)°，(28.2±3.2)° and (50.3±3.3)°(P<0.05).The proportions of type Ⅰ，type Ⅱ，type Ⅲ and type Ⅳ in the experimental group were 50%，40.6%，0 and 9.4%，in the control group，they were 12.5%，15.6%，40.6%，and31.3%，respectively.among them：the type Ⅰ and type Ⅱ in the experimental group was higher than that of the control group，(P<0.05)，the type Ⅲ and type Ⅳ in the experimental group was lower than that in the control group(P<0.05).Conclusion Low PI is more likely to cause the recurrence of lumbar disc herniation after transforaminal endoscopic discectomy.Roussouly type Ⅰ and type Ⅱ lumbar disc herniation have a higher chance of recurrence after transforaminal endoscopic discectomy，should be chose carefully for transforaminal endoscopic discectomy and protection after surgery should be used.

Key words： transforaminal endoscopic discectomy lumbar disc herniation postoperative recurrence spine pelvic sagittal shape Roussouly classification

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[1]	. [J]. sygkzz, 2021, 27(7): 632-637.