经椎板间入路和经椎间孔入路脊柱内镜下治疗L5-S1椎间盘突出症的临床疗效比较

Comparison of theclinical effects of interlaminar and transforaminal percutaneous endoscopic discectomy for L5-S1 disc herniation

目的回顾性分析经椎板间入路(PEID)和经椎间孔入路(PETD)行脊柱内镜手术治疗L5-S1椎间盘突出症的临床疗效。方法选取2017年1月-2018年3月行脊柱内镜下髓核摘除手术治疗的114例L5-S1椎间盘突出症患者(其中PEID手术56例,PETD手术58例),对比两种手术疗效。结果两组患者均顺利完成手术,PEID组手术时间和透视次数均显著少于PETD组,差异有统计学意义(P<0.05)。两组患者末次随访的VAS评分和ODI评分均较术前明显改善(P<0.05),但组间差异无统计学意义(P>0.05)。根据改良MacNab标准,PEID组优良率为85.7%,PETD组优良率为86.2%,两组差异无统计学意义(P>0.05)。PEID组出现3例硬脊膜撕裂(无脑脊液漏),2例神经根损伤(均经保守治疗后好转),6例短暂性下肢症状加重,2例术后复发;PETD组未出现硬脊膜撕裂,2例神经根损伤(1例经保守治疗后恢复,1例永久性损伤),3例出现短暂的下肢症状加重,3例术后复发。结论PEID与PETD均可以用于L5-S1椎间盘突出症的治疗。二者相互补充,其中PEID手术时间短,透视次数少,但硬脊膜和神经根损伤风险较PETD高。临床应用中应根据解剖特点,并结合操作者的熟练程度选择手术合适的入路。

Objective To retrospectively analyze the clinical effects of percutaneous endoscopic discectomy for L5-S1 disc herniation via interlalminar(PEID)and transforaminal(PETD).Methods From January 2017 to March 2018,114 patients with L5-S1 disc percutaneous endoscopic discectomy(PEID 56 cases,and PETD 58 cases)were collected,to compare the effect of two kinds of operation.Results The discectomy of all the patients were successfully completed by percutaneous endoscope.The operation time and fluoroscopy times in PEID group were significantly shorter than those in PETD group(P<0.01).The VAS score and ODI score at the last follow-up of the two groups were significantly improved compared with before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).According to the modified MacNab standard,the excellent and good rate of PEID group was 85.7%,and that of PETD group was 86.2%.There was no statistically significant difference between the two groups(P>0.05).There were 3 cases of dural tear(no cerebrospinal fluid leakage),2 cases of nerve root injury(all improved after conservative treatment),6 cases of transient lower extremity symptoms and 2 cases of recurrence after operation in PEID group,2 cases of nerve root injury(1 case recovered after conservative treatment and 1 case of permanent injury),3 cases of transient lower extremity symptoms and 3 cases of recurrence after operation.Conclusion Both PEID and PETD can be used in the treatment of L5-S1 disc herniation.PEID has shorter operation time and fewer fluoroscopy times,but the risk of dural and nerve root injury is higher than that of PETD.In clinical application,the appropriate approach should be selected according to the anatomical characteristics and the proficiency of the operator.