侧后路经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的效果

Clinical effect of percutaneous transforaminal posterolateral endoscopic discectomy on patients with lumbar disc herniation

目的探讨侧后路经皮椎间孔镜下髓核摘除术(PTED)治疗腰椎间盘突出症(LDH)的效果。方法选择2019年1月至2021年1月南阳南石医院收治的98例LDH患者为研究对象,按随机数字表法分为开窗髓核摘除术(FD)组与PTED组,每组49例。FD组接受FD治疗,PTED组接受侧后路PTED治疗。比较两组手术效果、围术期指标、术前、术后1个月、3个月Oswestry功能障碍指数问卷表(ODI)评分、术前、术后3 d疼痛介质[一氧化氮(NO)、5-羟色胺(5-HT)]水平。结果PTED组优良率为93.88%(46/49),FD组为77.55%(38/49),差异有统计学意义(P<0.05)。PTED组术中失血量少于FD组,下床活动时间、切口长度短于FD组(P<0.05)。PTED组术后1个月、3个月ODI评分低于FD组(P<0.05)。PTED组术后3 d血清NO、5-HT水平低于FD组(P<0.05)。结论侧后路PTED治疗LDH患者效果明显,可有效优化围术期指标,改善患者腰椎功能,并利于减轻其术后疼痛感。

Objective To investigate the effect of posterolateral percutaneous transforaminal endoscopic discectomy(PTED)on lumbar disc herniation(LDH).Methods Ninety-eight LDH patients from January 2019 to January 2021 in Nanyang Nanshi Hospital were selected and divided into group FD and group PTED according to random number table method,with 49 cases in each group.Group FD underwent fenestration of the nucleus pulposus(FD)and group PTED underwent posterolateral PTED.The results of surgery,perioperative indexes,scores of Oswestry Disability Index(ODI)before surgery,1 month and 3 months after surgery,and levels of pain mediates[nitric oxide(NO)and 5-HT before and after surgery]were compared between the two groups.Results The excellent and good rate of group PTED was 93.88%(46/49),which was higher than that of group FD(77.55%,38/49),the difference was significant(P<0.05).The intraoperative blood loss in group PTED was less than that in group FD,and the time of getting out of bed and incision length were shorter than those in group FD on the 3rd day after operation(P<0.05).The ODI score of group PTED was lower than those of group FD at 1 month and 3 months after surgery(P<0.05).The serum levels of NO and 5-HT in group PTED were lower than those in group FD on the 3rd day after operation(P<0.05).Conclusions The treatment of LDH by posterolateral PTED is effective,which can optimize the perioperative parameters,improve the lumbar function and relieve the postoperative pain.