椎板间入路与椎间孔入路内窥镜椎间盘切除术治疗L_5S_1椎间盘突出症的比较

Interlaminar versus transforaminal approaches in percutaneous endoscopic discectomy for L5 S1 lumbar disc herniation

[目的]比较椎间孔入路和椎板间入路经皮内窥镜椎间盘切除术治疗L5S1椎间盘突出症(LDH)的临床疗效。[方法]回顾性分析本院2014年12月~2016年12月49例接受经皮内窥镜手术治疗L5S1LDH的资料,根据手术方式不同分为两组,23例采用椎板间入路(PEID组),26例采用椎间孔入路(PETD组)。采用疼痛视觉模拟评分(VAS)和功能障碍指数(ODI)评分比较两种手术方式的临床疗效。[结果]两组患者在年龄、性别、LDH病理分型、临床症状、术前VAS疼痛评分、ODI功能障碍指数评分组间差异无统计学意义(P>0.05)。PEID组与PETD组相比显著缩短手术时间[(63.53±15.85)mins vs(75.27±11.34)mins,P<0.05],显著减少术中X线透视次数[(8.49±1.89)次vs(35.38±6.08)次,P<0.05),差异有统计学意义。两组患者均未出现定位错误、硬膜撕裂、手术切口感染、椎间盘炎等严重并发症。49例患者平均随访15.3个月。两组患者术后24h、末次随访VAS疼痛评分以及末次随访ODI功能障碍指数评分与术前相比明显降低(P<0.05),各时间点两组间差异无统计学意义。两组患者并发症发生率PEID组4.35%,PETD组7.69%,差异无统计学意义(P>0.05);短期复发率PEID组4.35%,PETD组11.54%,差异无统计学意义(P>0.05)。[结论]PEID与PETD均是治疗L5S1LDH安全、有效、微创的手术方式,且临床疗效相近。但PEID能明显缩短手术时间、减少术中透视次数。

[Objective] To compare the clinical outcomes of interlaminar versus transforaminal approaches in percutaneous endoscopic discectomy for the L5 S1 lumbar disc herniation（LDH）. [Methods] A retrospective study was conducted on 49 patients who underwent percutaneous endoscopic discectomy for L5 S1 LDH in our hospital from December 2014 to December2016. Of them, 23 patients received percutaneous endoscopic interlaminar discectomy（PEID）, while the remaining 26 patients underwent percutaneous endoscopic transforaminal discectomy（PETD）. The visual analogue scale（VAS） and Oswestry Disability Index（ODI） were applied for evaluation of the clinical consequences. [Results] There were on significant differences in age,gender, pathologic type of LDH, clinical symptoms, preoperative VAS and ODI between the two groups（P 0.05）. Compared with PETD group, the PEID group proved significantly shorter operation time [（63.53±15.85） mins versus（75.27±11.34） mins,P〈0.05], less times of X-ray fluoroscopy [（8.49±1.89） times versus（35.38±6.08） times, P〉0.05], with statistical differences between them. No serious complications, such as position error, dural tear, surgical incision infection and discitis occurred in any patient of the two groups. The VAS scores 24 hours after operation and at the last follow-up, as well as the ODI scores at the last follow-up in both groups were significantly lower than those before operation（P〈0.05）, although no significant differences in VAS and ODI were noticed between the two groups at any corresponding time points. The complication incidence was4.35% versus 7.69%（P〉0.05）, whereas the short-term recurrence proved 4.35% versus 11.54%（P〉0.05）, without statistical differences between the two groups. [Conclusion]Both PEID and PETD are safe, effective and minimally invasive surgical procedures for L5 S1 LDH with similar satisfactory results. However, the PEID takes advantages of shortened operation time and reduced number of intraoperative fluoroscopy over the PETD.