经微创通道与经皮椎间孔镜髓核摘除术治疗极外侧型腰椎间盘突出症的比较

Comparison of clinical effect between minimally invasive channel and percutaneous transforaminal endoscopic discectomy in treatment of far lateral lumber disc herniation

目的比较经微创通道髓核摘除术与经皮椎间孔镜髓核摘除术治疗极外侧型腰椎间盘突出症的疗效,并总结手术适应证及操作技巧。方法回顾性分析自2012-01—2016-01诊治的32例极外侧型腰椎间盘突出症,12例行微创通道下髓核摘除术(微创通道组),20例行经皮椎间孔镜髓核摘除术(椎间孔镜组)。比较2组手术时间、术中出血量,术后3个月疼痛VAS评分、ODI指数,以及末次随访时MacNab疗效评定结果。结果 32例均获得随访,随访时间平均14个月,随访期间均未复发。微创通道组与椎间孔镜组手术时间比较差异无统计学意义(P>0.05);但椎间孔镜组术中出血量明显少于微创通道组,差异有统计学意义(P <0.05)。微创通道组与椎间孔镜组术后3个月疼痛VAS评分、ODI指数、MacNab疗效评定结果差异无统计学意义(P>0.05)。结论经微创通道与经皮椎间孔镜髓核摘除术治疗极外侧型腰椎间盘突出症安全有效,不破坏手术节段稳定性,临床疗效相似,但经皮椎间孔镜手术创伤更小。然而高髂棘、横突肥大、腰骶角度过大、巨大髓核脱出钙化患者不适宜采用这两种手术。

Objective To compare the clinical effect of minimally invasive channel discectomy and percutaneous transforaminal endoscopic discectomy in the treatment of far lateral lumber disc herniation and summarize operation indications and operative techniques.Methods Thirty-two cases of lateral lumbar disc herniation or lumbar spinal stenosis treated from January 2016 to Janaury 2016 were retrospectively analyzed.Among 32 cases,minimally invasive channel discectomy were conducted on 12 patients(minimally invasive channel group),while 20 patients received percutaneous transforaminal endoscopic discectomy(percutaneous transforaminal endoscope group).The data of these two groups were compared in terms of duration of operation,bleeding volume within surgery,VAS scores and ODI index in 3 month follow-up and MacNab evaluation of the last follow-up.Results All cases were followed up for an average time of 14 months,and no recurrence was observed within follow-up period.There was no statistical difference in duration of operation between two groups(P>0.05).However,the bleeding volume within surgery significantly reduced in percutaneous transforaminal endoscope group when compared to minimally invasive channel group(P<0.05).Furthermore,there was no remarkable difference in VAS scores,ODI index and MacNab evaluation of follow-up between two groups(P>0.05).Conclusion Both minimally invasive channel discectomy and percutaneous transforaminal endoscopic discectomy are safe and effective techniques in the treatment of far lateral lumber disc herniation.But,patients with overhigh iliac spine,large transverse processes,wide lumbosacral angle and extrusive nucleus pulposus calcification are not suitable for these two operations.