经皮椎间孔镜腰椎间盘摘除术与微创经椎间孔腰椎融合术治疗腰椎间盘突出症的前瞻性随机对照研究

Percutaneous Endoscopic Lumber Discectomy Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Disc Herniation: a Prospective Randomized Controlled Study

目的比较经皮椎间孔镜腰椎间盘摘除术（percutaneous endoscopic lumbar discectomy,PELD）与Quadrant通道辅助微创经椎间孔腰椎融合术（minimally invasive transforaminal lumbar interbody fusion,Mis-TLIF）治疗腰椎间盘突出症的临床效果。方法 2010年1月-2013年12月,选择经保守治疗无效的腰椎间盘突出症60例,按随机数字表中随机数的奇数和偶数分为2组,每组30例。2组年龄、性别、病变节段、临床诊断、影像学检查差异无统计学意义（P〉0.05）,由同一组脊柱外科医师手术,分别行PELD（TESSYS椎间孔镜系统）和Quadrant通道辅助Mis-TLIF。随访12-24个月,平均16.2月,比较2组手术时间、术中出血量、住院时间、疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、JOA评分、改良Mac Nab标准评定,以及并发症的种类和发生率。结果与Mis-TLIF组相比,PELD组的手术时间短[（72.0±18.7）min vs.（137.0±48.3）min,t=-6.857,P=0.000],术中出血少[（28.0±14.7）ml vs.（314.0±13.6）ml,t=-11.831,P=0.000],住院时间短[（4.0±1.0）d vs.（10.0±3.0）d,t=-9.298,P=0.000]。术后2周和术后3个月PELD组腰腿痛的VAS评分优于Mis-TLIF组（P〈0.05）。术后3、12个月PELD组ODI、JOA评分明显优于Mis-TLIF组（P〈0.05）。2组术后12个月Mac Nab评级无统计学差异（P〉0.05）。2组并发症发生率差异无显著性。结论 PELD和Quadrant通道辅助Mis-TLIF治疗腰椎间盘突出症均可取得满意的临床疗效,前者切口小,手术时间短,出血少。

Objective To compare clinical outcomes of percutaneous endoscopic lumber discectomy（ PELD） versus minimally invasive transforaminal lumbar interbody fusion（ Mis-TLIF） under the Quadrant system in the treatment of lumbar disc herniation. Methods From January 2010 to December 2013,60 patients with lumbar disc herniation and failed to conservative treatment were enrolled in this study. According to the random number table,the patients were divided into two groups,with 30 patients in each group. There were no significant differences in age,gender,segment of disease,clinical diagnosis,and imaging results between the two groups（ P〉0. 05）. The surgery of PELD under the TESSYS endoscopic system or Mis-TLIF under the Quadrant system was performed by a same surgical team. Follow-up was conducted for 12-24 months（ mean,16. 2 months）. The operation time,blood loss,hospital stay,visual analogue scores（ VAS） for back and leg pain,Oswestry disability index（ ODI）,Japanese Orthopaedic Association（ JOA） scores,Mac Nab criteria,and complications were compared between the two groups.Results As compared with the Mis-TLIF group,the PELD group had significantly shorter operation time [（ 72. 0 ± 18. 7） min vs.（ 137. 0 ± 48. 3） min,t =-6. 857,P = 0. 000],less intraoperative blood loss [（ 28. 0 ± 14. 7） ml vs.（ 314. 0 ± 13. 6） ml,t =-11. 831,P = 0. 000],and shorter hospitalization stay [（ 4. 0 ± 1. 0） d vs.（ 10. 0 ± 3. 0） d,t =-9. 298,P = 0. 000]. The scores of VAS of back and leg pain at 2 weeks and 3 months postoperation in the PELD group was lower than the Mis-TLIF group（ P〈0. 05）.The scores of ODI and JOA at 3 and 12 months postoperation in the PELD group were superior to the Mis-TLIF group（ P〈0. 05）. No significant difference was recorded in the Mac Nab criteria at 12 months postoperation between the two groups（ P〉0. 05）. There wasno significant difference in complication rate between the two groups. Conclusions Both PELD and Mis-TLIF are safe and effective for lumbar disc herniation. PELD has smaller incision,shorter operation time,and less blood loss as compared with Mis-TLIF.