椎间孔入路与椎板间入路经皮椎间孔镜手术治疗单节段腰椎间盘突出症的疗效比较

Comparison of percutaneous endoscopic lumbar discectomy via transforaminal and interlaminar approach in treatment of single-segment lumbar disc herniation

目的比较全身麻醉下椎间孔入路(PETD)与椎板间入路(PEID)经皮椎间孔镜手术治疗腰椎间盘突出症的疗效。方法回顾性分析自2012-03—2016-01在全身麻醉下采用经皮椎间孔镜手术治疗的123例单节段腰椎间盘突出症,PETD组45例,PEID组78例。比较2组手术时间、术中X线透视次数,以及术后1 d、3个月、12个月、24个月JOA评分、疼痛VAS评分、ODI指数。结果 PEID组手术时间明显短于PETD组,术中X线透视次数少于PETD组,差异有统计学意义(P <0.05)。123例均获得随访,随访时间24～38个月,PETD组随访(27.2±4.5)个月,PEID组随访(28.7±3.2)个月。PEID组与PETD组术后1 d、3个月、12个月、24个月时JOA评分、疼痛VAS评分、ODI指数比较差异无统计学意义(P>0.05)。结论 PETD与PEID入路经皮椎间孔镜技术治疗单节段腰椎间盘突出症均可以显著改善患者疼痛症状,术后恢复快。在严格把握腰椎间盘突出类型及手术适应证的前提下,PEID入路手术时间更短,术中X线透视次数更少,而且全身麻醉下手术可避免术中患者出现疼痛和恐惧。

Objective To compare the effect of percutaneous endoscopic transforaminal discectomy(PETD)and percutaneous endoscopic interlaminar discectomy(PEID)for single-segment lumbar disc herniation under general anesthesia.Methods The clinical data of 123 patients with single-segment lumbar disc herniation treated under general anesthesia was analyzed retrospectively from March 2012 to January 2016.There were 45 cases in PETD group and 78 cases in PEID group.The operation time,intraoperative fluoroscopy times,and the JOA,VAS,ODI at 1 day,3 months,12 months,and 24 months after surgery were compared.Results The operation time and intraoperative fluoroscopy times of PEID group was significantly less than that of PETD group(P<0.05).All patients were followed up for 24 to 38 months.The PETD group was followed up for(27.2±4.5)months,and the PEID group was followed up for(28.7±3.2)months.There was no significant difference in JOA,VAS and ODI between PEID and PETD at 1 day,3 months,12 months and 24 months postoperatively(P>0.05).Conclusion PETD and PEID for single-segment lumbar disc herniation can significantly ease pain of patients with rapid recovery after surgery.PEID has shorter operation time and fewer intraoperative fluoroscopy times under the premise of grasping the type of disc protrusion and surgical indications.Moreover,surgery under general anesthesia can avoid pain and fear in operation.