完全内镜下经椎板间入路治疗腰椎间盘突出症的对比研究

Contrast study of full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation

目的 评价完全内镜下经椎板间入路治疗腰椎间盘突出症的微创性与有效性.方法 从2008年8月至2009年2月在完全内镜下经椎板间入路治疗的腰椎间盘突出症患者中选取28例为完全内镜组,其中男性16例,女性12例;年龄20～51岁,平均（36±8）岁;病程18～120 d,平均（68±26）d;突出位置L5～S1 22例,L4～5 6例.从同期采用头灯辅助开放小切口治疗的腰椎间盘突出症患者中选取28例为开放小切口组,其中男性17例,女性11例;年龄17～53岁,平均（35±9）岁;病程19～110 d,平均（66±24）d;突出位置L5～S1 15例,L4-5 13例.对两组患者的手术时间、术中出血量、住院时间、并发症发生情况以及术前、术后3个月和末次随访时腿痛和腰痛VAS评分情况进行对比分析.结果 患者均获随访,完全内镜组与开放小切口组平均随访时间分别为1.8年和1.7年;平均手术时间分别为（71±30）min和（60±12）min,差异无统计学意义（P＞0.05）;术中平均出血量完全内镜组极少而未予统计,开放小切口组为（59±10）ml;平均住院时间分别为（5.7±1.4）d和（12.3±3.0）d,差异有统计学意义（P＜0.01）;并发症发生率分别为7.1%和10.7%,差异无统计学意义（P＞0.05）.两组均无复发病例.术后3个月腿痛和腰痛VAS与同组术前比较差异均有统计学意义（P＜0.01）,而未次随访与术后3个月比较差异无统计学意义（P＞0.05）.末次随访时两组VAS腿痛评分比较差异无统计学意义（P＞0.05）,VAS腰痛评分比较差异有统计学意义（P＜0.01）.结论 与头灯辅助开放小切口技术相比,完全内镜下经椎板间入路治疗腰椎间盘突出症同样可获得良好的临床疗效,且创伤更小、术后恢复更快.

Objective To evaluate the minimally invasive efficacy and surgical outcome of fullendonscopic discectomy via interlaminar approach for lumbar disc herniation （LDH）. Methods From August 2008 to February 2009, 56 patients with lumbar disc herniation were retrospectively studied. The patients were divided into two groups according to the surgical methods. Full endoscopic discectomy （FED）group included 16 males and 12 females, the age was 20-51 years with a mean （36 ±8） years, and the course of disease was 18-120 d with a mean （68 ±26） days. There was L5-S1 LDH in 22 and L4-5 LDH in 6.Headlamp-assisted mini-open discectomy （HAMOD） group, there were 17 males and 11 females. The age was 17-53 years with an average age of （35 ±9） years, the course of disease was 19-110 d with an average （66 ±24） days, and the herniated disc located at L5-S1 in 15 cases, and L4-5 in 13 cases. Perioperative parameters （operation time, bleeding volume and length of hospital stay ）, complications and VAS of leg and back pain （preoperatively, 3 months postoperatively and final follow-up） were statistically analyzed.Results All patients were followed up in both groups, and the average follow-up time of full endoscopic was 1.8 years, and headlamp assisted mini-open was 1.7 years. The average operation time in full endoscopic group was （71 ±30） min and the headlamp group was （60 ± 12） min, which there was no statistical difference （P 〉 0. 05 ）. There was no measurable bleeding in full endoscopic group, and the headlamp group was （59 ± 10）ml. The average hospital days in full endoscopic group was （5.7 ± 1.4） days, and the headlamp group was （12.3 ± 3.0） days, there was statistically significant difference in both groups （P〈0.01）. The complication rate in full endoscopic group was 7.1%, and in headlamp group was 10.7%, without statistical difference （ P 〉 0. 05 ）. There was no recurrent case in either group. With regard to VAS of back pain and leg pain, statistically significant difference was found in each group between preoperatively and 3 months postoperatively, but not between 3 months postoperatively and at final follow-up.With regard to the final follow-up VAS, there was no statistical difference in leg pain between full endoscopic and headlamp group （P 〉 0. 05 ）. However, there was statistical significance in VAS back pain between the two groups （P 〈 0. 01 ）. Conclusions Compared to the headlamp assisted mini-open technique, the fullendoscopic interlaminar approach for the surgical treatment of lumbar disc herniation can achieve similar clinical outcomes with advantage of less iatrogenic trauma and sooner rehabilitation.