椎板开窗髓核摘除术与经皮椎间孔镜治疗腰椎间盘突出症加速康复的对比分析

Comparison of enhanced recovery in LDH using a fenestration discectomy or percutaneous transforaminal endoscopic discectomy

目的探讨腰椎后路椎板开窗髓核摘除术(fenestration discectomy,FD)与经皮椎间孔镜(percutaneoustransforaminal endoscopic discectomy, PTED)对单节段腰椎间盘突出症患者的组织损伤及加速康复的影响。方法前瞻性研究2016年3月至2017年3月收治的28例腰椎间盘突出症(L4-5或L5-S1)患者,其中14例患者行腰椎后路椎板开窗髓核摘除术,14例行经皮椎间孔镜髓核摘除术,记录两组患者的年龄、性别、突出节段、手术切口长度、手术时间、术中出血量、卧床时间、住院时间、并发症以及检测肌酸激酶(serum creatinekinase,CK)、C反应蛋白(C-reaction protein, CRP)、白介素-6(interleukin-6, IL-6)。于术前、术后1个月、术后3个月三个时间点记录疼痛视觉模拟评分(VAS)及OSWESTRY功能障碍指数评定(ODI)进行随访,所得数据进行统计学分析。结果所有患者随访均超过3个月。两组的手术出血量、切口长度、卧床时间、住院时间,PTED组优于FD组,差异有统计学意义,手术时间无统计学差异;CK、CRP、IL-6术后较术前明显升高并有统计学差异,CK组间比较术后第1、2、3天均有统计学差异,PTED组低于FD组,CRP、IL-6在术后第1、2天有统计学差异,PTED组低于FD组,术后第3天无统计学差异。与术前相比较,术后1个月、3个月VAS及ODI评分差异有显著统计学意义,但两组组间评分无统计学差异。结论 FD与PTED治疗单节段腰椎间盘突出症均有效,PTED具有对组织损伤小,住院时间短,术后加速康复,可作为治疗单节段腰椎间盘突出症的有效方式。

Objective To compare enhanced recovery of two surgical treatment of lumbar disc herniation:Fenestration discectomy(FD)and Percutaneous transforaminal endoscope discectomy(PTED).Methods From March 2016 to March2017,28 cases with Lumbar disc herniation(LDH)at L4-5 or L5-S1 were treated either FD or PTED,each with 14 cases.Record the data of the two groups,including age,gender,segmental lesions,incision length,operation time,amount of bleeding,ambulation time,length of hospital stays,complications,and serum creatinekinase(CK),Creaction protein(CRP),interleukin-6(IL-6).Two groups of patients were assessed with visual analog scale(VAS)and Oswestry Disability Index(ODI)for three times,before surgery,the 1 st month after surgery,3 months after surgery.The above results all be statistically analyzed.Results There were no significant differences in mean preoperative gender,age,segmental lesions,CK,CRP,IL-6,VAS score,ODI score between groups FD and PTED.Amount of bleeding,incision length,ambulation time,and length of hospital stay were better in the PTED group(P<0.05).Duration of the operation was not statistical significance.CK、CRP、IL-6 in postoperation were much higher than preoperation(P<0.05).Between the two groups,CK were less in the PTED group(P<0.05)in 3 days after surgery(P<0.05).CRP、IL-6 were less in the PTED group than FD group(P<0.05)on the first and second day after operation,whereas there was no difference on the third day after operation.VAS scores and ODI scores were significantly better than preoperative in two groups(P<0.01).There were no differences between the 2 groups in ODI scores and VAS scores after 1 and 3 months.Conclusion FD and PTED were all reliable techniques for the treatment of LDH.Combined with advantages of reduced surgical trauma,shorter time in bed and hospital stays by minimally invasive surgery,PTED can result in enhanced recovery,which can be used as an effective treatment of LDH.