侧路椎间孔镜与后路椎间盘镜治疗腰椎间盘突出症疗效比较

Lateral percutaneous endoscopic lumbar discectomy versus posterior micro-endoscopic discectomy for lumbar disc herniation

[目的]探讨经皮椎间孔镜微创技术治疗腰椎间盘突出症的临床疗效。[方法]2016年3月~2017年6月120例经保守治疗无效的腰椎间盘突出症患者120例行手术治疗,其中60例行侧路椎间孔镜术,60例行后路椎间盘镜术。比较两组疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)和Nakai分级。[结果]120例患者均顺利完成手术。椎间孔镜组手术时间和透视时间显著长于椎间盘镜组(P<0.05),椎间孔镜组术中失血量、术后下地时间和住院时间显著少于椎间盘镜组(P<0.05)。两组患者术后VAS和ODI评分较术前均显著减少(P<0.05)。术后1周时椎间孔镜组的VAS评分显著低于椎间盘镜组(P<0.05)。术后3个月时椎间孔镜组的ODI评分显著低于椎间盘镜组(P<0.05)。120例中88例(73.33%)患者获得随访6~12个月,其中椎间孔镜组52例,椎间盘镜组36例。随访过程中,椎间孔镜组有4例术后1~6个月复发,行翻修术,椎间盘镜组2例发生神经根牵拉伤,术后背伸无力,3个月后恢复。两组随访并发症发生率差异无统计学意义(P>0.05)。椎间孔镜组优良率为90.38%(47/52),椎间盘镜组优良率为80.56%(29/36),两组间差异有统计学意义(P<0.05)。[结论]经皮椎间孔镜腰椎间盘切除术较椎间盘镜有更好的疗效。

[Objective]To compare the clinical outcomes of lateral percutaneous endoscopic lumbar discectomy versus posterior micro-endoscopic discectomy for lumbar disc herniation.[Methods]From March 2012 to June 2013,a total of 120 patients underwent surgical treatment for lumbar intervertebral disc prolapse after failure of conservative treatment in our department.In term of surgical procedures conducted,60 patients had lateral percutaneous endoscopic lumbar discectomy(PELD),while the remaining 60 patients received posterior micro-endoscopic discectomy(PMED).The visual analogue scale(VAS)for pain,Oswestry disability index(ODI and Nakai criteria were recorded and compared between 2 groups.[Results]All 120 patients were successfully completed the operation.The operation time and fluoroscopy time of the PELD group were significantly longer than the PMED group(P<0.05).The blood loss,postoperative time and hospital stay in the PELD group were significantly less than those in the PMED group(P<0.05).The VAS and ODI scores of 2 groups were significantly lower than those before surgery(P<0.05).The VAS score of the PELD group was significantly lower than that of the PMED group at 1 week after operation(P<0.05).The ODI score of the PELD group was significantly lower than that of the PMED group at 3 months after operation(P<0.05).Of the 120 patients,88 cases(73.3%)were followed up for 6 to 12 months,including 52 cases in the PELD group and 36 cases in the PMED group.During the follow-up period,4 patients in the PELD group recurred 1-6 months after surgery,and underwent revision surgery.Two patients in PMED group developed nerve root traction injury.The postoperative extension was recovered after 3 months.There was no significant difference in the follow-up complications between 2 groups(P>0.05).The excellent and good rate of the PELD group was 90.38%(47/52),and the excellent and good rate of the PMED group was 80.56%(29/36).The difference between 2 groups was statistically significant(P<0.05).[Conclusion]The PELD is superior to the PMED in clinical outcomes.