经皮椎间孔镜与开放椎板间开窗术治疗腰椎间盘突出症的疗效分析

Efficacy of two surgical treatment of lumbar disc herniation:percutaneous transfouraminal endoscope discectomy(PTED) and fenestration discectomy

目的评价经皮椎间孔镜椎间盘切除术(PTED)与传统开放椎板间开窗术两种手术方式治疗经保守治疗无效的腰椎间盘突出症患者的近期临床疗效。方法回顾分析两种单节段手术患者30例,其中16例患者行PTED术,14例行椎板间开窗术,记录两组术前、术后资料,包括性别、年龄、病程、手术节段、手术时间、出血量和卧床时间等,于术前、术后1周、术后1个月和术后大于6个月的随访行疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数评定(ODI),并按中华骨科学会脊柱学组腰背痛手术评分标准评价两组手术临床疗效,所得以上结果进行统计学分析。结果两组患者均随访,平均随访时间28.4个月,对两种手术疗效进行比较,比较两组的出血量、卧床时间和手术时间差异有统计学意义(P<0.05);两组术后1个月、末次随访VAS及ODI评分差异均无统计学意义(P>0.05);末次随访PTED组优良率为87.50%,传统开窗组优良率为71.42%,两组疗效优良率比较差异无统计学意义(P>0.05)。结论 PTED是传统手术的微创化,其结合传统术式与经皮穿刺技术的优势能直接到达突出椎间盘位置,摘除病变髓核,直接解除椎管内压迫,在减少手术创伤的同时,达到与传统术式相似的疗效,可作为治疗腰椎间盘突出症的有效可靠术式。

Objective To evaluate the short-term efficacy of two surgical treatment of lumbar disc herniation： percutaneous transfouraminal endoscope discectomy（PTED） and fenestration discectomy, which were no effect by conservative treatment. Methods Rospectively analyzed 30 cases with two surgical treatment, 16 cases in PTED group,the other 14 cases in fenestration discectomy. Record the data of two groups, including gender, age, disease duration,segmental lesions, operation time, amount of bleeding, ambulation time, et al. Two groups of patients were assessed with VAS and ODI for four times, before surgery, 1 week after surgery, 1 month after surgery, more than 6 months after surgery. The surgery efficacy of two groups can be judge with the low back pain surgery scoring criteria which is formulated by Chinese Academy of Orthopaedic spine group. The above results all be statistically analyzed.Results All patients were followed up, the average follow-up time was 28.4 months. These differences were statistically significant in the operation time, amount of bleeding, ambulation time between two groups（P〈0.05）. The score of VAS and ODI after surgery was no differences between the two groups, and had no statistically significant（P〉0.05）. The Excellent rate of PTED group is 87.50%, with 71.42% to fenestration group, but it was no statistically significant（P〉0.05）. Conclusion Combined with the advantages of traditional surgical and percutaneous techniques,PTED achieves the minimally invasive of traditional surgery, which can directly reach the herniated disc position, remove the diseased nucleus pulposus. And directly release the compression of Spinal canal. PTED could not only reduce surgical trauma, and receive the similar results as the traditional operation, which should be used as an effective treatment of lumbar disc herniation.