经皮椎间孔镜与显微内窥镜治疗腰椎间盘突出症的前瞻性随机对照研究

Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy for lumbar disc herniation:a prospective randomized controlled study

目的比较经皮椎间孔镜(percutaneous transforaminal endoscopic discectomy,PTED)和显微内窥镜(microendo-scopic discectomy,MED)在腰椎间盘切除术中的临床疗效。方法采用前瞻性随机对照研究的方法,将2007年12月至2008年6月术前确诊为单节段腰椎间盘突出症的60例患者,随机分为PTED组和MED组,各30例。手术效果按照Oswestry功能障碍指数(Oswestry disability index,ODI)、疼痛视觉类比评分(visual analogue scale,VAS)和改良的Macnab标准评定。结果所有病例均顺利完成手术。两组病例的椎间盘突出类型、手术时间、术后随访时间及并发症的发生率均无明显差异,但PTED组平均手术失血(7±2)ml,术后卧床1d。MED组平均手术失血(48±13)ml,术后卧床3～5d(平均4.2d)。按照改良的MacNab法评定优良率分别为90%和93%,两组无显著性差异(P>0.05)。PTED组和MED组术后ODI、VAS与术前比较,均明显改善(P<0.05)。结论PTED和MED两种微创术式治疗腰椎间盘突出症的短期疗效均满意。在严格选择手术适应证的情况下,PTED具有切口小、出血少、创伤小和术后恢复快等微创优势,是一种安全有效的微创手术方法。

Objective To compare the clinical effectiveness of percutaneous transforaminal endoscopic discectomy （PTED） with microendoscopic discectomy （MED） in the treatment of lumbar disc herniation. Methods In this prospective randomized controlled study, a total of 60 matched patients preoperatively diagnosed as single lumbar disc herniation from December 2007 to June 2008 in our department were randomly divided into 2 groups, 30 patients in each. They received discectomy as above mentioned. The Oswestry disability index （ ODI）, visual analogue scale （ VAS）, and modified MacNab criteria were employed to measure the clinical outcomes. Results All the procedures were performed successfully. There was no significant difference between the 2 groups on disc herniation types, operative time, fellow-up time and complication rate. But FlED group had an average blood loss of 7 ± 2 ml, and were postoperatively kept in bed for a mean duration of 1 d, while for MED group, the loss blood was 48 ± 13 ml, and a mean stay-in-bed was 4.2 d （ranging from 3 to 5 d）. According to the modified Macnab criteria, 90% of patients in PELD group showed excellent or good outcomes while 93 % of patients in MED group had such outcomes. There was no significant difference in this between the 2 groups （ P 〉 0.05）. VAS and ODI were significantly improved in the 2 groups compared with those before operation （P 〈0.05）. Conclusion The short-term outcome of FlED for lumbar disc herniation is similar to that of MED if the patients are selected strictly according to tile indications. FlED has the advantages of smaller incision, lesser bleeding, lesser tissue impairment and quicker recovery. It is a safe and efficacious minimally invasive surgical technique.