经椎板间完全内镜下与椎间盘镜下L_5/S_1椎间盘切除术的中期临床疗效比较

Comparison of mid-term clinical efficacy between percutaneous endoscopic interlaminar discectomy and micro-endoscopic discectomy in L_5/S_1intervertebral disc resection

目的探讨经椎板间完全内镜下与椎间盘镜下L_5/S_1椎间盘切除术的中期临床效果差异。方法选取2014年4月-2016年7月在该院骨科进行L5/S1椎间盘切除手术的90例患者,随机分为对照组[使用椎间盘镜下腰椎间盘切除手术(MED)]和观察组[使用经皮椎间孔镜腰椎间盘切除手术(PTED)],每组各45例患者,比较两组患者的手术效果。结果两组患者手术持续时间、手术切口大小和平均住院时间比较,差异有统计学意义(P<0.05),观察组低于对照组,对照组与观察组手术前、手术后3 d、手术后30 d、手术后半年和手术后1年的腰部疼痛视觉模拟评分比较,采用重复测量设计的方差分析,结果:(1)不同时间的视觉模拟评分差异有统计学意义(F=11.587,P=0.000);(2)两组的VAS评分差异有统计学意义(F=15.368,P=0.000),经过q检验,对照组与观察组的差异有统计学意义,对照组得分高于观察组,其余各时间的数据差异均无统计学意义;(3)两组的视觉模拟评分变化趋势差异有统计学意义(F=11.615,P=0.000),两组术前、术后3 d、手术后30 d、手术后半年和手术后1年的腿部疼痛视觉模拟评分比较,采用重复测量设计的方差分析,结果:(1)不同时间的视觉模拟评分差异有统计学意义(F=15.664,P=0.000);(2)两组的视觉模拟评分差异有统计学意义(F=9.865,P=0.000),经过q检验,两组差异有统计学意义,对照组得分高于观察组,其余各时间的数据差异无统计学意义;(3)两组的视觉模拟评分变化趋势差异有统计学意义(F=18.334,P=0.000),两组患者手术1年后治疗效果比较,差异有统计学意义(Z=3.691,P=0.000),对照组治疗效果要优于观察组,对照组共发生不良反应5例,观察组共发生不良反应4例,两组数据比较,差异无统计学意义(χ~2=0.123,P=0.725)。结论在摘除椎间盘L5/S1段的突出物手术中,PTED的短期效果比MED更好,在远期效果上,两种手术方法的结果趋向于一致,但前提是在手术前必须对患者的情况进行综合考虑,并且仔细研读患者的影像学资料,保证手术方法的正确选择。

Objective To compare the mid -term clinical efficacy between percutaneous endoscopic interlaminar discectomy （PEID） and micro-endoscopic discectomy （MED） in L5/S1 intervertebral disc resection. Methods A total of 90 patients who underwent L5/S1 intervertebral resection in our hospital from April 2014 to July 2016 were included and randomly divided into control group （45 patients received MED） and observation group （45 patients received PEID）. Surgical related parameters were compared. Results Operation time, incision size and average hospitalization time in the observation group were significantly lower than those in the control group （P 〈 0.05）. The waist and leg pain VAS scores were compared between the control group and the observation group before operation and 3 d, 30 d, half a year and one year after surgery. There was a significant difference at each time point in the waist and leg pain VAS scores （ F= 11.587,P = 0.000;F =15.664,P = 0.000, respectively）; there was a significant difference between the control group and the observation group in the waist and leg pain VAS scores （ F= 15.368,P = 0.000;F = 9.865,P =0.000,respectively）; Q test showed that the waist and leg pain VAS scores of the control group were significantly higher than those of the observation group. There was a significant difference in the changing trend of the waist and leg pain VAS scores between the control group and observation group （F = 11.615,P = 0.000;F =18.334, P= 0.000, respectively）. There was significant difference in clinical efficacy one year after surgery between the control group and the observation group （Z = 3.691,P = 0.000）. The control group had a better clinical efficacy than the observation group. There were 5 cases in the control group and 4 cases in the observation group that experienced adverse events but the difference was not statistically significant （x2 =0.123,P = 0.725）. Conclusions The mid-term clinical efficacy of PEID is better than that of MED in the L5 / S1 intervertebral disc resection, but these two surgical methods have a similar variation tendency in the longterm outcome. We suggest a comprehensive consideration of patients＇ condition and imaging data before surgery to ensure the proper surgical methods.