PELD与MED治疗内镜术后复发性腰椎间盘突出症

PELD versus MED for recurrent herniation subsequent to endoscopic lumbar discectomy

[目的]比较经皮内镜下腰椎间盘切除术(PELD)与显微内窥镜下椎间盘切除术(MED)治疗内镜术后复发性腰椎间盘突出症的临床疗效。[方法]回顾性分析本院2012年3月~2017年10月行PELD和MED手术的内镜术后复发性腰椎间盘突出症患者57例,其中PELD 30例,MED 27例,比较两组患者的切口长度、手术时间、术中出血量、透视次数、住院时间及费用。采用VAS评分、ODI评分、改良MacNab评分评价手术疗效。[结果]所有患者均顺利完成手术,PELD组出血量较MED组少,切口长度较MED组短,而透视次数较MED组多,差异有统计学意义(P<0.05);两组患者在手术时间、住院时间和住院费用方面差异无统计学意义(P>0.05)。术后两组VAS评分及ODI评分均较术前明显减少(P<0.05)。在术后3 d时PELD组腰痛VAS评分、ODI评分优于MED组(P<0.05),腿痛VAS评分差异无统计学意义(P>0.05)。在术前、术后3、6个月及末次随访时,两组腰痛VAS评分、腿痛VAS评分及ODI评分比较差异均无统计学意义(P>0.05)。末次随访改良MacNab评分评价疗效,PELD组优22例,良5例,可2例,差1例,优良率为90.00%;MED组优22例,良3例,可1例,差1例,优良率为92.59%;两组优良率比较,差异无统计学意义(P>0.05)[结论]两种微创手术方式均能有效地治疗PELD术后复发性腰椎间盘突出症,PELD在术中出血量、切口长度及早期缓解患者腰痛方面具有优势,MED术中透视次数相对更少。

[Objective]To compare the clinical outcomes of PELD versus MED for recurrent herniation subsequent to endoscopic lumbar discectomy.[Methods]A retrospective study was conducted on 57 patients who underwent surgical treatment for recurrent herniation after endoscopic lumbar discectomy from March 2012 to October 2017.Of them,30 patients received PELD,while the other 27 patients had MED.The length of the incision,operation time,blood loss,frequency of fluoroscopy,hospital stay,hospital costs were compared between the two groups.The clinical outcomes were evaluated with visual analogue scale(VAS)for pain,Oswestry disability index(ODI)and modified MacNab′s criteria.[Results]The PELD group had significantly shorter incision length,less blood loss,whereas more X-ray exposure than the MED group(P<0.05),regardless of no significant differences in operation time,hospital stay and hospital costs between the two groups(P>0.05).Both VAS and ODI in the two groups significantly decreased after operation compared with those before operation(P<0.05).The VAS for lower back pain and ODI were significantly higher in the MED group than PELD group at 3 days after surgery(P<0.05),nevertheless no significant difference was found in VAS for the leg between them(P<0.05).However,no significant differences regarding the VAS and ODI scores were proved at 3 and 6 months,as well as the latest follow-up after surgery between the two groups(P<0.05).At the latest follow-up,the clinical outcomes were graded as excellent in 22,good in 5 cases,fair in 2 and poor in 1 of the PELD group with excellent rate of 90.00%,whereas excellent in 22,good in 3,fair in 1 and poor in 1 of the MED group with excellent rate of 92.59%based on the modified MacNab criteria,which was not statistically significant(P>0.05).[Conclusion]Both PELD and MED are effective procedures for treatment of recurrent herniation subsequent to endoscopic lumbar discectomy.By comparison,the PELD takes advantages of better relief of lower back pain,shorter incision length and less blood loss,whereas the MED has a benefit of less X-ray exposure.