经皮椎间孔镜下髓核摘除术与小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症患者的对比研究

Comparative Study on Percutaneous Transforaminal Nucleus Pulposus and Small Incision Interlaminar Nucleus Pulposus Extraction for Lumbar Disc Herniation

目的:对比经皮椎间孔镜下髓核摘除术与小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症(LDH)的临床价值。方法:选取我院60例LDH患者(2016年11月至2018年2月期间收治),将行经皮椎间孔镜下髓核摘除术者分为椎间孔镜组,将行小切口椎板间开窗髓核摘除术分为小切口组,每组30例。对比两组手术及术后恢复情况、术后并发症发生率,随访至术后6个月,对比两组手术疗效、功能改善情况[Oswestry功能障碍指数(ODI)、日本矫形外科评分(JOA)]及生活质量(SF-36)评分。结果:手术及术后恢复情况:椎间孔镜组切口长度、手术用时、术后卧床时间及住院时间短于小切口组,手术出血量及椎间盘切除量少于小切口组(P<0.05);术后并发症:椎间孔镜组术后并发症发生率6.67%(2/30)低于小切口组26.67%(8/30)(P<0.05);手术疗效:椎间孔镜组手术疗效优良率86.67%(26/30)与小切口组83.33%(25/30)比较无显著差异(P>0.05);功能改善情况:术后6个月,椎间孔镜组与小切口组ODI指数及JOA评分均较手术前改善(P<0.05),但两组间比较无显著差异(P>0.05);生活质量:术后6个月,椎间孔镜组与小切口组SF-36评分均较手术前提高,且椎间孔镜组高于小切口组(P<0.05)。结论:经皮椎间孔镜下髓核摘除术与小切口椎板间开窗髓核摘除术治疗LDH,均可取得显著手术效果,改善患者功能障碍、提高腰椎功能,但前者较后者更具微创优势,手术创伤小、术后恢复快,更利于改善患者术后生活质量。

Objective: To compare the clinical value of percutaneous transforaminal nucleus pulposus and small incision interlaminar nucleus pulposus removal for lumbar disc herniation (LDH). Methods: 60 patients with LDH in our hospital from November 2016 to February 2018 were enrolled. Percutaneous transforaminal nucleus pulposus removal was divided into intervertebral foramen. The nucleus pulposus extraction was divided into small incision groups, 30 cases in each group. The operation and postoperative complications were compared between the two groups. The follow-up to 6 months after surgery, the efficacy and functional improvement of the two groups were compared [Oswestry dysfunction index (ODI), Japanese orthopedic surgery score (JOA)] and quality of life (SF-36) score were counted. Results: Surgery and postoperative recovery: The length of the incision in the intervertebral foramen group, the time of surgery, the time of bed rest and the length of hospital stay were shorter than that of the small incision group. The amount of surgical bleeding and discectomy was less than that of the small incision group (P<0.05). Postoperative complications: The incidence of postoperative complications in the vertebral foramen group was 6.67%(2/30), which was lower than that in the small incision group (26.67%(8/30)(P<0.05);Surgical efficacy: The excellent and good rate of surgery in the intervertebral foramen group was 86.67%(26/30), and there was no significant difference between the small incision group and 83.33%(25/30)(P>0.05). Functional improvement: postoperative 6 The ODI index and JOA score of the intervertebral foramen and small incision group were improved compared with those before operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Quality of life: postoperative At 6 months, the SF-36 scores of the intervertebral foramen group and the small incision group were higher than those before the operation, and the intervertebral foramen group was higher than the small incision group (P<0.05). Conclusion: Percutaneous transforaminal nucleus pulposus and small incision interlaminar nucleus pulposus extraction for LDH can achieve significant surgical results, improve patient dysfunction and improve lumbar function, but the former is more than the latter. The advantages of minimally invasive surgery, small trauma and quick recovery after surgery are more conducive to improving the quality of life of patients after surgery.