经皮椎间孔镜治疗L4/5和L5／S1椎间盘突出症与开放手术的比较研究

Comparative study on treatment of 14/5 and LS/s1 intervertebral disc herniation and open surgery by percutaneous intervertebral foramen

目的：探讨经皮椎间孔镜治疗L4/5和L5/S1与传统开放手术比较研究.方法：回顾性分析2016年1月～2017年12月于我院及第一作者2017年在中山大学孙逸仙纪念医院骨科进修期间的64例L4/5和L5/S1椎间盘突出症患者的临床资料.按照随机数字表法将患者分为对照组与观察组各32例,对照组实施传统的开放手术,观察组则采用改良的同轴脊柱内镜操作系统（YESS）技术经皮椎间孔镜治疗.观察2组手术时间、手术前后疼痛程度、术中术后并发症及功能障碍情况.结果：观察组平均手术时间、术中出血量以及术后住院时间均优于同期对照组,P〈0.05;观察组术中、术后并发症发生率分别为3.13%、9.38%,明显低于对照组18.75%、21.88%,差异对比有意义,P〈0.05;术前2组VAS评分与ODI指数对比差异无统计学意义,P〉0.05;术后对比发现,观察组VAS评分与ODI指数较术前及同期对照组有明显改善,差异对比有意义,P〈0.05.结论：采用改良YESS技术经皮椎间孔镜治疗L4/5和L5/S1单节段腰椎间盘突出症疗效显著,有效缓解患者临床症状,且手术创伤小、并发症少,是一项安全可靠、值得推广的重要术式.

Objectiv： To explore the comparative study of the treatment of 14/5 and 15/s1 in the treatment of 14/5 and 15/s1. Methods： a retrospective analysis in January 2016 to December 2017 in our hospital and in 2017 first author during the sun yat - sen memorial hospital, sun yat - sen university orthopaedic study of 64 cases of L4/5 and L5 / S1 intervertebral disc herniation in patients with clinical data. According to random number table method divided the patients into control group and experimental group, 32 cases in control group to implement the traditional open surgery, the experimental group, the use of the modified coaxial spinal endoscope operation system （YESS） technology of percutaneous intervertebral foramen mirror treatment. The duration of operation, the degree of postoperative pain, postoperative complications and dysfunction of the two groups were observed. Results： the average operation time, intraoperative blood loss and postoperative hospital stay were better than those in the control group, P 〈 0.05. The incidence rate of postoperative complications was 3.13% and 9.38% respectively, significantly lower than 18.75% and 21.88% in the control group, and the difference was significant, P 〈 0.05 ; There was no statistically significant difference between the two groups of VAS score and ODI index in the first two groups, P BBB 0. 05 ; Postoperative comparison found that the VAS score and ODI index in the experimental group were significantly improved compared with those in the control group before the operation and compared with the control group in the same period. The difference was significant, P 〈 0.05. Conclusion： modified YESS treatment technology of percutaneous intervertebral foramen mirror L4/5 and L5 / S1 single segmental lumbar disc curative effect was distinct, effectively relieve the clinical symptoms, and small surgical trauma, fewer complications, was one of the important operation for safe and reliable.