后路椎板开窗和经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的疗效比较

Comparison of the curative effect of posterior laminectomy and percutaneous foraminal nucleus pulposus in the treatment of lumbar disc herniation

目的比较后路椎板开窗髓核摘除术和经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症(LDH)的临床疗效。方法选择浙江省绍兴市柯桥区中医医院医共体总院2017年10月-2019年10月收治的LDH患者74例,随机分成内镜组和开窗组,每组37例。内镜组采用经皮椎间孔镜下髓核摘除术治疗,开窗组采用后路椎板开窗髓核摘除术治疗。比较两组临床和手术指标(手术时间、术中出血量、切口长度和卧床时间),并对两组疼痛(VAS评分)和腰椎功能(ODI评分)进行评价,并采用Macnab标准比较两组疗效。结果内镜组手术时间、术中出血量、手术切口长度、卧床时间均优于开窗组,差异有统计学意义(P<0.05);内镜组术后3天、3个月VAS评分、ODI评分均优于开窗组,差异有统计学意义(P<0.05);两组疗效、术后1年VAS评分及ODI评分、并发症发生率差异均无统计学意义(均P>0.05)。结论后路椎板开窗和经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症总体疗效相当,但经皮椎间孔镜下髓核摘除术创伤小、恢复快,患者接受度高。

Objective To have a comparison of clinical efficacy for lumbar disc herniation(LDH)treatment between nucleus pulposus removal via posterior vertebral lamina fenestration and percutaneous transforaminal endoscopic nucleus pulposus removal.Methods A total of 74 patients with LDH were randomized into endoscopy group and fenestration group,37 patients each group.Relevant treatment was performed by percutaneous transforaminal endoscopic nucleus pulposus re-moval for the endoscopy group,and by nucleus pulposus removal via posterior vertebral lamina fenestration for the fenestration group.Relevant clinical indicators(operative time,intraoperative blood loss,incision length and bed time)were compared between the two group,and at the same time,an evaluation on the pain(VAS score)and lumbar function(ODI score)were conducted for the two groups.Macnabmethod was used to have a comparison of efficacy between the two groups.Results The endoscopy group was superior to the fenestration group in operative time,intraoperative blood loss,incision length and bed time(P<0.05),and in VAS score and ODI score 3 days and 3 months after surgery as well(P<0.05).For the differences in efficacy(excellent rate),VAS score and ODI score 1 year after surgery between the two groups,there was no statistical significance(P>0.05).Conclusion The nucleus pulposus removal via posterior vertebral lamina fenestration and percutaneous transforaminal endoscopic nucleus pulposus removal were comparable in overall effect for LDH treatment,but the latter were more acceptable for minimal invasion and fast postoperative recovery.