经皮椎板间入路与椎间孔入路椎间孔镜下髓核摘除术治疗L_5/S_1椎间盘突出症的疗效分析

The effective of percutaneous endoscopic lumbar discectomy for L_5/S_1 disc herniation via an interlaminar approach versus a transforaminal approach

目的探讨经皮椎板间入路椎间孔镜下髓核摘除术(PEID)与经皮椎间孔入路椎间孔镜下髓核摘除术(PETD)治疗L_5/S_1椎间盘突出症的临床疗效。方法收集2014年9月至2016年6月本院脊柱外科收治的L_5/S_1椎间盘突出症患者102例,其中接受PEID患者52例(PEID组),PETD患者50例(PETD组)。比较两组患者透视次数、手术时间、术后复发率及其他并发症发生情况,并通过术前、术后3个月及末次随访时视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)以及末次随访时MacNab标准评价两组患者的临床疗效。结果所有患者均获得随访,随访时间12～18个月。PEID组透视次数3～6(3.8±2.1)次,手术时间44～72(58.3±12.0)min,PETD组透视次数13～24(24.1±10.1)次,手术时间52～96(82.4±16.0)min,两者比较差异均有统计学意义(P<0.05)。两组患者术后3个月及末次随访VAS评分和ODI评分较术前明显改善(P<0.05),但差异无统计学意义(P>0.05)。末次随访时MacNab标准评价PEID组优良率96.1%,PETD组优良率96%,差异无统计学意义(P>0.05)。结论采用椎板间入路或椎间孔入路椎间孔镜下髓核摘除术治疗L_5/S_1椎间盘突出症临床疗效均确切。椎板间入路可以明显减少术中透视次数,节约手术时间。

Objective To compare the clinical results of percutaneous endoscopic interlaminar discectomy （PEID） and percutaneous endoscopic transforamina] discectomy （PETD） in LS/S1 disc hernia- tion. Methods A total of 102 patients with L5/S1 disc herniation in our hospital from September 2014 to June 2016 were enrolled in this study. Fifty-two patients underwent percutaneous endoscopic interlaminar discectomy （PEID group ） and 50 patients underwent percutaneous endoscopic transforaminal discectomy （ PETD group）. The surgical effectiveness was assessed according to Visual Analog Scale （VAS） , Oswestry Disability Index （ODI） , and modified MacNab criteria. The frequencies of intraoperative radiation expo- sure, operation time and complication rates were compared between the groups. Results All the patients completed follow up with a mean of 15.0 months （range, 10 -20 months）. In the PEID group, the mean operation time was 44- 72 （58.3 ± 12. 0）minutes and the intraoperative frequencies of radiation exposure were 3 -6（3.8 ±2.1）seconds. For the PETD group, the mean operation time was 52 -96（82. 4 ± 16. 0）minutes and the intraoperative radiation time was 13 -34 （24. 1 -!-- 10. 1 ）seconds. There were significant differences in operation time and radiation frequency between the two groups （ P 〈 0. 05 ）. The postoperative VAS and ODI were obviously improved in both groups when compared with preoperation （ P 〈 0. 05 ） , but there were no significant differences between the two groups （P 〉 0. 05）. There was no statistically signifi- cant difference considering the satisfactory rates according to the MacNab criteria between PEID group （96. 1% ） and PETD group （96.0%）. Conclusions The treatment of L5/S1 disc herniation through lamina or intervertebral foramen approach is both effective. PEID can significantly reduce the frequencies of intraoperative radiation exposure and operation time.