椎间孔镜与椎间盘镜治疗腰椎间盘突出症5年疗效比较

A Comparison of 5-year Follow-up Therapeutic Effects Between Percutaneous Endoscopic Lumbar Discectomy and Microendoscopic Discectomy for Lumbar Disc Herniation

目的比较经皮椎间孔镜(percutaneous endoscopic lumbar discectomy,PELD)与后路椎间盘镜(microendoscopic discectomy,MED)治疗单节段腰椎间盘突出症5年的临床疗效。方法回顾性分析2011年1月~2012年12月我院采用脊柱内窥镜技术治疗358例单节段腰椎间盘突出症患者资料,共210例(58.7%)获得至少5年随访。根据术前医患沟通,患者自主选择术式,行椎间孔镜(PELD组,86例)或椎间盘镜手术(MED组,124例)。记录2组术前、术后5年腰及下肢疼痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、改良MacNab标准优良率,采用Mochida方法测量手术间隙高度比,通过腰椎屈伸位椎间隙角度评价腰椎稳定性,记录术后并发症及复发率。结果2组腰及下肢疼痛VAS评分、ODI术后5年均较术前显著降低(P=0.000),2组间差异无显著性(P>0.05)。根据改良MacNab标准,术后5年PELD组和MED组优良率分别为84.0%(63/75)、89.0%(105/118),差异无统计学意义(χ^2=1.010,P=0.315)。PELD组和MED组并发症发生率分别为5.8%(5/86)和4.8%(6/124),差异无统计学意义(χ^2=0.000,P=1.000)。PELD组术后复发率(12.8%,11/86)显著高于MED组(4.8%,6/124)(χ^2=4.316,P=0.038)。术后5年PELD组手术间隙高度比为术前的(84.1±5.2)%,MED组为(72.9%±3.0)%,MED组较PELD组高度丢失更明显(t=17.033,P=0.000)。均无手术节段失稳或腰椎滑脱。结论PELD与MED是治疗椎间盘突出症的理想方法,均能取得良好的远期疗效,但PELD术后复发率较高,需要严格把握手术适应证,提高手术技巧。

Objective To compare 5-year follow-up therapeutic effects between percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in the treatment of single segmental lumbar disc herniation (LDH).Methods The clinical data of 358 patients with single segmental LDH treated by spinal endoscopy from January 2011 to December 2012 was retrospectively analyzed.A total of 210 patients (58.7%) were followed up for at least 5 years.These patients were divided into either PELD group ( n =86) or MED group ( n =124) depends on preoperative communication between doctors and patients.The 5-year follow-up data were obtained to evaluate each group’s clinical outcome with the Visual Analogue Scale (VAS) of low back pain and leg pain,the Oswestry disability index (ODI),and the modified MacNab criteria.The disc-height ratio was measured by the Mochida method.The lumbar stability was evaluated by the change of lumbar intervertebral space.The postoperative complications and recurrence rate were also recorded.Results The VAS of low back pain and leg pain and ODI at the 5-year follow-up were obviously lower than those before operation in each group (P=0.000),but there was no significant difference between the PELD group and MED group (P>0.05).According to the modified MacNab criteria,the excellent-or-good rates at the 5-year follow-up were 84.0%(63/75) in PELD group and 89.0%(105/118) in MED group,respectively,without significant difference (χ^2 =1.010,P =0.315).The complication rates were 5.8%(5/86) in PELD group and 4.8%(6/124) in MED group,without significant difference (χ^2 =0.000,P =1.000).The postoperative recurrence rate in PELD group (12.8%,11/86) was much higher than that in MED group (4.8%,6/124)(χ^2 =4.316,P =0.038).The disc-height ratio at 5-year follow-up was (84.1±5.2)% of the preoperative disc height in PELD group while (72.9±3.0)% in MED group,with significant height loss in MED group ( t =17.033,P =0.000).There was no intervertebral instability and lumbarspondylolisthesis in both groups after 5-year postoperative follow-ups.Conclusions PELD and MED are ideal surgical methods for the treatment of LDH with good and long-term curative effects.However,postoperative recurrence rate is relatively higher in the PELD group,thus the indications for surgery should be grasped strictly and surgical skills should be improved as well.