侧后路椎间孔镜与后侧椎板间入路脊柱内镜在腰椎间盘突出症髓核摘除术中的应用对比

Comparison of Application of Posterolateral Transforaminal Endoscopy and Spinal Endoscopy Via Posterior Interlaminar Approach in Extraction of Nucleus Pulposus for Lumbar Disc Herniation

目的:分析侧后路椎间孔镜与后侧椎板间入路脊柱内镜在腰椎间盘突出症髓核摘除术中的应用效果。方法:选择2020年1月—2022年12月龙岩市第二医院收治的80例腰椎间盘突出症患者作为研究对象,将2020年1月—2021年6月收治的40例设为A组,采取侧后路椎间孔镜下腰椎间盘突出症髓核摘除术;将2021年7月—2022年12月收治的40例设为B组,采取后侧椎板间入路脊柱内镜下腰椎间盘突出症髓核摘除术。记录并比较两组手术相关指标与并发症发生率,并于术后评价两组疼痛程度与功能恢复情况。结果:A组手术时间长于B组,术中出血量少于B组,手术切口长度短于B组,差异有统计学意义(P<0.05);但两组住院时间比较,差异无统计学意义(P>0.05)。术后48 h、1周,两组视觉模拟评分法(VAS)评分均低于术后24 h,且A组低于B组,差异有统计学意义(P<0.05)。术后4周、3个月,两组Oswestry功能障碍指数(ODI)评分均低于术前,且B组低于A组,差异有统计学意义(P<0.05)。A组术后并发症总发生率为15.00%,高于B组的10.00%,但两组间比较差异无统计学意义(P>0.05)。结论:侧后路椎间孔镜与后侧椎板间入路脊柱内镜两种手术方案各有优劣,前者术后疼痛程度更轻,出血量更少,后者手术时间更短、腰椎功能恢复更快,两者并发症风险相当。

Objective:To analyze the application effect of posterolateral transforaminal endoscopy and spinal endoscopy via posterior interlaminar approach in the extraction of nucleus pulposus for lumbar disc herniation.Method:A total of 80 patients with lumbar disc herniation admitted to the Second Hospital of Longyan City from January 2020 to December 2022 were selected as the study objects.Forty cases admitted from January 2020 to June 2021 were set as group A and underwent extraction of nucleus pulposus for lumbar disc herniation under posterolateral transforaminal endoscopy.Forty cases admitted from July 2021 to December 2022 were assigned as group B and underwent extraction of nucleus pulposus for lumbar disc herniation under spinal endoscopy via posterior interlaminar approach.The operative indicators and complication rate of the two groups were recorded and compared,and the pain degree and functional recovery of the two groups were evaluated after surgery.Result:The surgery time of group A was longer than that of group B,the intraoperative blood loss was less than that of group B,and the surgical incision length was shorter than that of group B,the differences were statistically significant(P<0.05);however,there was no significant difference in the hospital stay between two groups(P>0.05).At 48 h and 1 week after surgery,the visual analogue scale(VAS)scores in two groups were lower than those at 24 h after surgery,and those in group A were lower than those in group B,the differences were statistically significant(P<0.05).At 4 weeks and 3 months after surgery,Oswestry disability index(ODI)scores in two groups were lower than those before surgery,and those in group B were lower than those in group A,the differences were statistically significant(P<0.05).The total incidence of postoperative complications in group A was 15.00%,which was higher than 10.00%in group B,but there was no statistical significance between two groups(P>0.05).Conclusion:Posterolateral transforaminal endoscopy and spinal endoscopy via posterior interlaminar approach spine surgery have their respective advantages and disadvantages,the former has less postoperative pain and less bleeding,while the latter has shorter operative time and faster recovery of lumbar function,and the risk of complications is similar between the two.