Disc-FX System经皮髓核钳夹术与开窗减压术治疗伴根性痛的包容性腰椎间盘突出症的临床疗效比较

THE COMPARISON OF CLINICAL OUTCOMES OF PERCUTANEOUS LUMBAR DISC ECTOMY WITH DISC-FX SYSTEM WITH FENESTRATION AND DECOMPRESSION FOR CONTAINED LUMBAR DISC HERNIATION (LDH) WITH RADICULAR PAIN

目的:评估Disc-FX System经皮髓核钳夹术与传统开窗减压术相比,治疗伴单侧根性痛的包容性腰椎间盘突出症的安全性与临床疗效。方法:50例伴单侧根性痛的腰椎间盘突出症患者,随机分为2组,每组25例,Ⅰ组采用Disc-FX System经皮髓核钳夹术,在影像学引导下经后外侧入路、安全三角进入椎间盘进行减压;Ⅱ组采用传统开窗减压术。分别进行手术时间、出血量、并发症、术后住院时间比较,以及采用Oswestry功能障碍指数问卷表(Oswestry Disability Index,ODI)和视觉模拟评分(Visual Analog Scores,VAS)分别对两组疼痛效果进行术前和术后6周、3个月、6个月、12个月比较分析。结果:Ⅰ组手术时间、出血量和术后住院时间均显著少于Ⅱ组(P<0.01)。Ⅰ组未见并发症,Ⅱ组有2例硬膜撕裂。两组术前与术后6周、3个月、6个月、12个月ODI和VAS评分相比,均显著降低(P<0.01),但两组间术后ODI和VAS评分比较则无明显差异(P>0.05)。结论:Disc-FX System经皮髓核钳夹术能快速而有效达到椎间盘减压目的,具有操作简便、损伤小、安全性高等优点,并且具有与传统开窗术相似的疗效。

Objective： To compare the clinical outcomes of percutaneous lumbar discectomy with Disc-FX System（FX） with fenestration and decompression（FD） for contained lumbar disc herniation（LDH） with unilateral radicular pain.Methods： Patients underwent surgery either by FX（25 patients,group Ⅰ） or FD（25 patients,group Ⅱ） due to contained LDH with unilateral radicular pain at L4-5 or L5-S1 level.Comparison was made on operation time,blood loss,complication of surgery and length of post-operative hospital stay.The theraputic effect was evaluated by comparing Oswestry Disablity Index（ODI） and Visual Analgue Scores（VAS） 1 day before operation and 6 w,3 m,6 m and 12 m after operation.Results： The operation time,blood loss and length of hospital stay in group Ⅰ was significantly lower than that of group Ⅱ（P0.01）.There was no major complication in group Ⅰ,but Ⅱ cases in group Ⅱ with spinal dura mater injury.The VAS and ODI of 6 w,3 m,6 m and 12 m after operation were significantly lower than 1 day before operation in both groups（P0.01）,but there was no significant difference between the two groups after operation（P0.05）.Conclusion： Percutaneous lumbar discectomy with Disc-FX System can treat LDH effectively and safely.The method provides several advantages such as simplicity of operation,minimally invasive surgery and higher security,and can obtain clinical results as good as open discectomy.