椎间孔镜与单侧椎板开窗髓核摘除治疗腰椎间盘突出症对照观察

Comparative study of percutaneous transforaminal endoscopic discectomy versus unilateral vertebral lamina windowing discectomy for lumbar disc herniation

[背景]比较椎间孔镜与单侧椎板开窗髓核摘除治疗腰椎间盘突出症的临床疗效.[病例报告]选择2014年4月至2015年8月间诊断为单节段单侧腰椎间盘突出症的48例患者,按照抽签随机方法分为椎间孔镜治疗组（实验组,22例）和单侧椎板开窗髓核摘除组（对照组,26例）.随访时间为手术后1~5个月,平均为3个月.比较手术前后实验组和对照组的JOA评分、VAS评分及近期疗效.通过比较两组患者术后最后1次随访的改良MacNab标准优良率及JOA改善率进行术后疗效评价.两组患者均顺利完成椎间孔镜下髓核摘除术及单侧椎板开窗髓核摘除术,且术后均未见明显并发症,随访记录完整.实验组与对照组术后JOA评分和VAS评分均较术前明显提高（P〈0.05）,实验组术后随访的近期VAS评分和JOA评分均显著优于对照组术后（P〈0.05）.实验组优良率为90.90%,对照组为84.62%,实验组明显优于对照组（P〈0.05）.实验组末次随访的JOA改善率为86.36%,明显高于对照组的80.77%（P〈0.05）.[讨论]椎间孔镜下髓核摘除术近期疗效优于单侧椎板开窗髓核摘除术.

BACKGROUND To compare the clinical effects of percutaneous transforaminal endoscopic discectomy （PTED）and unilateral vertebral lamina windowing discectomy in the treatment of LDH. CASE REPORTS 48 patients who had been diagnosed as single-segment unilateral LDH were selected from April 2014 to August 2015. They were randomly divided into PTED group （the experimental group, 22 cases） and unilateral vertebral lamina windowing group （the control group, 26 cases）. Postoperative follow-up time was 1 to 5 months, an average of 3 months. JOA score, VAS score and short-term effects were used to compare the two groups before and after the operation. Modified MacNab standard excellent rate and JOA improvement rate of the last postoperative follow-up were used to evaluate the postoperative effects. All the patients in both groups were successfully completed the discectomy without postoperative complications. The record of follow-up was complete. The postoperative JOA and VAS scores in the two groups were significantly higher than the preoperative （P〈 0.05）. The postoperative JOA and VAS scores in the experimental group were better than those in the control group（P〈0.05）. The excellent rate was 90.90% in the experimental group and 84.62% in the control group, the experimental group was obviously better than the control group （P 〈 0.05）. The last follow-up JOA improvement rate was 86.36 % in the experimental group and 80.77% in the control group, the experimental group was apparently higher than the control group （P〈 0.05 ）.DISCUSSION The short-term curative effect of PTED was better than that of the unilateral vertebral lamina windowing discectomy.