经皮椎间孔镜与椎间盘镜髓核摘除术治疗腰椎间盘突出症的比较

Comparison of percutaneous endoscopic lumbar discectomy and microendoscopic discectomy for treatment of lumbar disc herniation

目的比较经皮椎间孔镜技术与椎间盘镜髓核摘除术治疗单节段腰椎间盘突出症的手术疗效。方法回顾性分析自2014-06—2016-06诊治的60例单节段腰椎间盘突出症,采用经皮椎间孔镜技术治疗30例(椎间孔镜组),采用椎间盘镜髓核摘除术治疗30例(椎间盘镜组)。比较2组切口长度、手术时间、术中出血量、术后住院时间,以及术后1周、术后3个月、术后6个月、末次随访时疼痛VAS评分、ODI指数。结果 60例均获得随访,随访时间平均22(12~36)个月。椎间孔镜组在切口长度、术中出血量、术后住院时间方面明显优于椎间盘镜组,但椎间孔镜组手术时间较椎间盘镜组长,差异有统计学意义(P <0.05)。椎间孔镜组与椎间盘镜组术后1周、术后3个月、术后6个月、末次随访时疼痛VAS评分、ODI指数比较差异无统计学意义(P>0.05)。结论经皮椎间孔镜和椎间盘镜髓核摘除术治疗腰椎间盘突出症均具有创伤小、出血少、并发症少和对腰椎后柱结构破坏小等优点,但相比之下,经皮椎间孔镜手术创伤相对更小,术后患者住院时间更短,患者接受程度更高。

Objective To compare the outcome of percutaneous endoscopic lumbar discectomy and microendoscopic discectomy in the treatment of single segment lumbar disc herniation. Methods A retrospective study of 60 cases of single segment lumbar disc herniation from June 2014 to June 2016 was conducted, 30 cases were treated with percutaneous endoscopic lumbar discectomy （PELD group）, and 30 cases were treated with microendoscopic discectomy （MED group）. The surgical incision length, operation time, intraoperative bleeding volume, postoperative hospital stay, VAS score and ODI index were compared between the two groups. Results All the 60 patients were followed up for 12-36 （average 22） months. PELD group was significantly better than MED group in surgical incision length, intraoperative bleeding volume, postoperative hospitalization time, the difference was statistically significant （P 〈0.05）. However, the operation time was longer in the PELD group, the difference was statistically significant （P 〈0.05）. There was no significant difference in pain VAS score and ODI index between PELD group and MED group at 1 week, 3 months, 6 months after operation, and at the last follow-up （P 〉 0.05）. Conclusion Both pereutaneous endoscopic lumbar discectomy and microendoscopic discectomy for treatment of lumbar disc herniation have the advantages of less trauma, less bleeding, less complications and small damage to the structure of the posterior column of the lumbar spine. However, for the percutaneous endoscopic lumbar discectomy the trauma is relatively smaller, and the patient＇s postoperative hospitalization time is shorter and the patient is more accepted,