经皮椎间孔镜技术治疗腰椎间盘突出症：椎间孔入路和椎板间入路的对照研究

A comparison of the transforaminal versus the interlaminar approach to percutaneous endoscopic surgeries in treating lumbar disc herniation

目的探讨经皮椎间孔入路椎间孔镜下椎间盘切除术（FLED）和经皮椎板间入路椎间孔镜下椎间盘切除术（PIED）治疗腰椎间盘突出症的适应证和临床疗效。方法回顾性纳入2014年4月至2015年6月北京医院神经外科和首都医科大学宣武医院神经外科收治的腰椎间盘突出症患者共126例，其中采用PTED治疗66例（FTED组），采用PIED治疗60例（PIED组），通过视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评价两组患者手术前后的疼痛改善情况，并比较两组的手术时间、透视次数、住院时间、并发症以及术后恢复情况。随访时间为3～23个月。结果与术前相比，两组术后VAS评分和ODI评分均明显改善（均P〈0．01）。两组在住院时间、手术优良率、复发率方面的差异均无统计学意义（均P〉0．05）。PTED组的手术时间[（85．6±19．0）min]和术中透视次数[（28．1±10．3）次]均多于PIED组[手术时间：（59．6±13．0）min；透视次数：（4．9±1．5）次]（均P〈0．01），而术后卧床时间[（4．6±0．9）h]、并发症发生率（4．5％）均低于PIED组[卧床时间：（9．9±3．7）h，并发症发生率：13．3％]（均P〈0．01）。结论PIED和PTED均为治疗腰椎间盘突出症安全、有效的手术方法，应根据腰椎间盘突出的类型和部位选择合适的手术方式。

Objective To evaluate the indications and clinical results of percutaneous transforaminal endoscopic disceetomy （FrED） and percutaneous interlaminar endoscopic discectomy （PIED） for the treatment of lumbar disc herniation （LDH）. Methods A total of 126 patients of LDH were retrospectively analyzed, who were admitted to Department of Neurosurgery, Beijing Hospital and Department of Neurosurgery, Xuanwu Hospital, Capital Medical University from April 2014 to June 2015. According to the surgical approach,the patients were divided into the PTED （66 eases） and PIED （60 cases） groups. Pre- and postoperative pain was assessed using the visual analog scale （VAS） and the patient＇ s functional status was evaluated using the Oswestry disability index （ODI）. Various aspects were compared between the two groups that included operation time, times of intraoperative radioactive examinations, length of hospital stay, complications and postoperative recovery. The follow-up time is 3 to 23 months. Results In both groups, the patients＇mean VAS scores and ODI were significantly decreased compared with data before operation（all P 〈0. 05）. There was no significant difference in length of hospital stay, rate of excellent/good outcomes or recurrence between 2 groups （ all P 〉 0. 05）. The operation time （85.6 ± 19.0 min） and frequencies of radiation exposure （28.1 ±10. 3） in the FrED group were significantly higher than in the PIED group （operation time：59.6 ± 13.0 min, frequency of radiation exposure ：4. 9± 1.5 ） ; while the postoperative bedridden time （4. 6 ± 0. 9 h） and complication rate （4.5%） in the FrED group were significantly lower than in the PIED group （bedridden time：9. 9 ±3.7 h, complication rate：13.3% ）. Condusions FrED and PIED are generally safe and efficacious in treatment of LDH. Selection of surgical approaches should be based on LDH types and locations.