动力磨钻辅助椎间孔镜治疗钙化型腰椎间盘突出症的疗效及对术后脊柱生物力学稳定性的影响OA

Objective To investigate the clinical efficacy of powered burr-assisted percutaneous endoscopic lumbar discectomy in the treatment of calcified lumbar disc herniation(CLDH)and its impact on postoperative spinal biomechanical stability.Methods This study is a retrospective case-control study.A total of 92 CLDH patients admitted to the Department of Orthopedic Surgery,Mudanjiang Forestry Center Hospital in Heilongjiang Province from January 2022 to January 2025 were collected as research subjects.According to different therapeutic methods,the patients were divided into observation group(treated with powered burr-assisted PELD,n=45)and control group(treated with conventional PELD,n=47).Propensity score matching method(PSM)was used to match the baseline data of the two groups with a caliper value of 0.02 and a 1:1 matching ratio,and 40 matched pairs were successfully obtained.The clinical data,clinical efficacy,imaging indicators before and after treatment,spinal range of motion(ROM),hip joint ROM,as well as visual analog scale(VAS)scores,Japanese Orthopaedic Association(JOA)scores,and Oswestry Disability Index(ODI)scores before and after treatment were compared between the two groups.A difference-in-differences model was used to analyze the changes in JOA,ODI,and VAS scores after treatment in the two groups.Pearson correlation analysis was employed to investigate the correlation between pelvic tilt(PT),lumbar lordosis(LL),sacral slope(SS),spinal sagittal and coronal ROM,hip joint sagittal and coronal ROM,and coronal ROM with JOA,ODI,and VAS scores.Results The total effective rate(92.5%vs.75.0%,P=0.034),the complete clearance rate of calcified lesions(95.0%vs.77.5%,P=0.023),and the complete nerve decompression rate(95.0%vs.80.0%,P=0.043)in observation group were significantly higher than those in control group after surgery.Compared with those before treatment,the JOA scores were significantly increased,while ODI and VAS scores were significantly decreased in both groups after treatment(P<0.05).Compared with control group,observation group had significantly higher JOA scores and significantly lower ODI and VAS scores after treatment(P<0.05).The difference-in-differences model showed that there were statistically significant differences in JOA,ODI,and VAS scores for the group factor,treatment time factor,and group×treatment time interaction term(P<0.05).The increased amplitude of JOA score and the decreased amplitudes of ODI and VAS scores in observation group were significantly higher than those in control group after treatment.Compared with preoperative values,both groups showed decreased PT,increased LL and SS,and increased spinal and hip joint sagittal and coronal ROM after treatment(P<0.05).Compared with control group after treatment,observation group exhibited significantly decreased PT,increased LL and SS,and greater increases in spinal and hip joint sagittal and coronal ROM after treatment(P<0.05).Pearson correlation analysis showed that PT was negatively correlated with JOA score,and positively correlated with ODI and VAS scores(P<0.05).LL,SS,spinal sagittal ROM and coronal ROM,and hip joint sagittal ROM and coronal ROM were positively correlated with JOA score,and negatively correlated with ODI and VAS scores(P<0.05).Conclusion Powered burr-assisted percutaneous endoscopic lumbar discectomy has significant clinical advantages in the treatment of CLDH,which can effectively alleviate pain,improve functional status,and enhance quality of life without compromising spinal stability,thus being worthy of clinical promotion and application.