利用椎间孔镜与显微镜治疗腰椎间盘突出症的效果比较

Comparison of Clinical Efficacy Between Transforaminal Endoscopic Discectomy and the Micro-endoscopic Discectomy for Lumbar Disc Herniation

目的:比较显微镜或椎间孔镜下椎间盘切除术对腰椎间盘突出症的围手术期及近期手术疗效。方法:回顾性分析2016年6月-2017年6月笔者所在医院收治的行手术治疗的腰椎间盘突出症患者33例。根据不同手术方式将其分为椎间孔镜组17例和显微镜组16例。椎间孔镜组采用椎间孔镜下椎间盘切除术,显微镜组采用显微镜下椎间盘切除术。比较两组患者切口长度、手术时间、住院时间、术中出血量、术中X线透视次数、术后1年内二次手术率及并发症发生情况,比较两组患者术前术后腰痛、下肢腿痛程度VAS评分、JOA评分及Oswestry功能障碍指数评分。结果:椎间孔镜组切口长度、术中出血量、住院时间均明显优于显微镜组(P<0.05)。两组手术时间、术后1年内二次手术率比较,差异均无统计学意义(P>0.05)。显微镜组术中X线透视次数明显优于椎间孔镜组,差异有统计学意义(P<0.05)。两组患者术后腰部与下肢疼痛程度VAS评分均低于术前(P<0.05);术后2周,椎间孔镜组患者腰部VAS评分低于显微镜组,差异有统计学意义(P<0.05);术后3个月和术后1年两组腰部和下肢VAS评分比较,差异均无统计学意义(P>0.05)。椎间孔镜组术后2周ODI和JOA评分均优于显微镜组,差异有统计学意义(P<0.05),术后3个月及术后1年两组患者ODI和JOA评分比较,差异均无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:椎间孔镜下椎间盘切除术与显微镜下椎间盘切除术相比,具有术中出血少、肌肉剥离少和术后恢复快等优点,术后近期效果好,是治疗腰椎间盘突出症的一种有效方法,具有良好的发展前途。

Objective:To compare the perioperative and short-term efficacy between transforaminal endoscopic discectomy and the micro-endoscopic discectomy for lumbar disc herniation.Method:A retrospective analysis was conducted on 33 patients with lumbar intervertebral disc herniation admitted in our hospital from June 2016 to June 2017.According to different surgical methods,the patients were divided into transforaminal endoscopic group(17 cases) and microscope group(16 cases).In the transforaminal endoscopic group,discectomy was performed under foraminoscopy,and in the microscopy group,discectomy was performed under microscope.The incision length,operation time,hospitalization stay,intraoperative blood loss,number of intraoperative X-ray fluoroscopy,rate of secondary surgery within 1 year after operation and complications were compared in two groups.VAS score,JOA score and Oswestry index score were compared between the two groups.Result:The incision length,intraoperative blood loss and hospitalization days in the transforaminal endoscopic group were significantly better than those in the microscopic group(P<0.05).There was no statistically significant difference in operation time and the rate of secondary surgery within 1 year after operation between the two groups(P>0.05).The number of intraoperative X-ray fluoroscopy in the microscope group was better than that in the transforaminal endoscopic group, the difference was statistically significant(P<0.05).The VAS scores of lumbar and lower limb pain after operation were lower than those before operation(P<0.05). Two weeks after the operation,the VAS score of lumbar in the transforaminal endoscopic group were lower than those in the microscope group,and the differences were statistically significant(P<0.05).The VAS scores of the lumbar and lower limbs of the two groups were compared 3 months after surgery and 1 year after surgery, there were no statistically significant differences(P>0.05).ODI and JOA scores in the transforaminal endoscopic group were better than those in the microscope group 2 weeks after operation(P<0.05).There was no statistically significant difference in ODI and JOA scores between the two groups 3 months and 1 year after surgery. Conclusion:Compared to microscopic discectomy,transforaminal endoscopic discectomy has the advantages of less intraoperative bleeding,less muscle dissection and rapid postoperative recovery.It is an effective method for the treatment of lumbar disc herniation and has a good development prospect.