两种经皮内镜经椎板间隙入路髓核摘除治疗L5/S1腰椎间盘突出症的对比研究

Comparison of two percutaneous endoscopic lumbar discectomy through trans-interlaminar approach in the treatment of L5/S1 lumbar disc herniation

目的比较椎间孔镜经椎板间隙入路与后路椎间盘镜保留黄韧带治疗L5/S1椎间盘突出症的临床疗效。方法 2010年2月-2012年9月符合入选条件的42例L5/S1椎间盘突出症患者按入院奇偶顺序分为两组。21例行椎间孔镜经椎板间隙入路髓核摘除术(PTED),21例行椎间盘镜保留黄韧带髓核摘除术(MED)。比较两种手术的透视次数、手术时间、出血量和住院天数。通过功能障碍指数(ODI)评分评价临床疗效。结果两组在透视次数、手术时间、出血量和住院天数差异无显著性(P>0.05),两组术后即刻、术后3个月和术后12个月时ODI评分较术前明显改善,差异有显著性(P<0.01)。两组间术前、术后即刻、术后3个月和术后12个月各时间段ODI评分差异无显著性(P>0.05)。结论椎间孔镜经椎板间隙入路与椎间盘镜保留黄韧带髓核摘除治疗L5/S1腰椎间盘突出症可取得满意的手术效果,具有手术创伤小,恢复快等优点,尤其适合L5/S1腰椎间盘突出症的治疗。

【Objective】To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy（PTED） and microendoseopic discectomy（MED） through trans-interlaminar approach in the treatment of L5/S1 lumbar disc herniation. 【Methods】From February 2010 to September 2012, 42 patients with L5/S1 disc herniation admitted were divided into 2 groups by admission parity order, 21 patients in PTED, 21 patients in MED. The fluoroscopy times, operation time, bleeding, hospitalization days and 0swestry disability index（ODI） were compared.【Results】There were no significant difference at fluoroscopy times, operation time, bleeding, duration of hospitalization between the two groups（ P〈0.05）. The ODI score of immediately postoperative, 3 months and 12 months after surgery were further improved than preoperative in both groups（ P〈0.01）. The ODI score of preoperative, immediately postoperative, postoperative 3 months and 12 months after surgery was no significantly difference between the two groups（ P〈0.05）.【Conclusion】Both PTED and MED through trans-interlaminar approach could achieve satisfied clinical efficacy, with minimal invasion, rapid postoperative recovery, which were suitable for L5/S1 lumbar disc herniation in particular.