椎间孔镜微创手术与腰椎开窗减压内固定术治疗腰椎间盘突出症的临床比较

Transforaminal endoscopic minimally invasive operation and lumbar fenestration and decompression internal fixation in treatment of lumbar disc herniation：A clinical comparison

目的 比较椎间孔镜微创手术与腰椎开窗减压内固定术治疗腰椎间盘突出症的临床效果.方法 选择我院收治的82例腰椎间盘突出症患者作为研究对象,随机分为对照组与观察组各41例.对照组采用常规腰椎开窗减压内固定手术治疗,观察组则采用椎间孔镜微创手术治疗,比较两组手术各指标的变化,采用视觉模拟评分表（VAS）评定患者术后疼痛程度,采用Oswestry功能障碍指数表（ODI）及日本骨科学会评分标准（JOA）评定患者日常生活能力的恢复情况,术后1年采用麦氏（Macnab）腰腿痛手术效果评定标准评估两组治疗效果,记录并发症发生率.结果 观察组手术时间、切口长度、住院时间均短于对照组[（75.65±15.12）min、（0.68±0.11）cm、（5.11±1.26）d比（126.81±5.74）min、（6.26±0.47）cm、（11.26±2.41）d],其术中出血量少于对照组[（26.36±10.55）ml比（300.26±11.26）ml]（P〈0.05）;观察组术后各并发症发生率均低于对照组,治疗优良率略高于对照组,但对比差异无统计学意义（P〉0.05）;两组术后48 h、72 h、96 h VAS评分均低于术后24 h（P〈0.05）,但观察组术后不同时间VAS评分均低于对照组[（3.31±0.56）分、（2.23±0.56）分、（1.16±0.26）分、（0.71±0.11）分比（5.36±1.22）分、（4.75±0.54）分、（3.24±0.37）分、（2.21±0.36）分]（P〈0.05）;观察组术后3、6、12个月ODI评分均低于对照组[（18.22±2.11）分、（10.23±1.77）分、（5.22±1.56）分比（26.87±3.26）分、（19.36±1.25）分、（10.21±1.28）分],JOA评分均高于对照组[（12.35±2.47）分、（20.36±1.78）分、（26.12±1.33）分比（8.21±1.26）分、（15.26±1.46）分、（22.21±1.02）分]（P〈0.05）.结论 采用椎间孔镜微创手术治疗腰椎间盘突出症,手术创伤小,总有效率高,患者术后恢复速度快,日常生活能力改善明显.

Objective To compare the clinical effects of transforaminal endoscopic minimally invasive operation and lumbar fenestration and decompression internal fixation in the treatment of lumbar disc herniation. Methods Eighty-two patients with lumbar disc herniation,who were hospitalized in our hospital,were included as the subjects in the study and randomly divided into the control group and the study group（n=41 each）. The control group was treated with conventional lumbar fenestration and decompression internal fixation, and the study group was treated with transforaminal endoscopic minimally invasive operation. The changes of the operation indexes between the two groups were compared. The postoperative pain degree was evaluated by visual analogue scale （VAS）. The recovery of the daily living ability was evaluated by Oswestry disability index table （ODI） and the scoring standard of Japanese Orthopaedic Association（JOA）. At one year after the operation,the Macnab evaluation criteria of the surgical effect in low back pain was used to evaluate the efficacy in both groups. The incidence of complications was recorded.＆amp;nbsp;Results The operation time,incision length and length of hospital stay in the study group were shorter than those in the control group[（75.65±15.12）min,（0.68±0.11）cm,（5.11±1.26）d vs（11.26±2.41）d,（6.26± 0.47）cm,（300.26 ± 11.26）ml],and the intraoperative blood loss was less than that in the control group [（26.36 ± 10.55）ml vs（126.81 ± 5.74）min]（P＆lt;0.05）. The incidence of postoperative complications in the study group was lower than that in the control group,and the excellent and good rate of treatment was slightly higher than that in the control group,and there were no statistically significant differences（P〉0.05）. At 48 h,72 h and 96 h after the operation,the VAS scores in the two groups were lower than those at 24h after the operation（P〈0.05）,whereas the VAS scores in the study group at different time points after the operation were lower than those in the control group[（3.31 ± 0.56）,（2.23 ± 0.56）,（1.16 ± 0.26）,（0.71 ± 0.11）vs （5.36±1.22）,（4.75±0.54）,（3.24±0.37）,（2.21±0.36）]（P〈0.05）. The ODI scores in the study group at 3, 6 and 12 months after the operation were lower than those in the control group [（18.22 ± 2.11）,（10.23 ± 1.77）,（5.22±1.56）vs（26.87±3.26）,（19.36±1.25）,（10.21±1.28）],whereas the JOA scores were higher than those in the control group[（12.35 ± 2.47）,（20.36 ± 1.78）,（26.12 ± 1.33）vs（8.21 ± 1.26）,（15.26 ± 1.46）,（22.21 ± 1.02）]（P〈0.05）. Conclusion Using transforaminal endoscopic minimally invasive operation in the treatment of lumbar disc herniation shows less surgical trauma,high total effective rate, rapid recovery rate,and significantly improved daily living ability in the patients.