侧入路经皮内镜与显微内镜下腰椎间盘切除术临床疗效的观察

Clinical study of two methods of lumbar intervertebral disc resection

目的分析比较侧入路经皮内镜下腰椎髓核摘除术(PELD)与后路显微内镜下腰椎间盘切除术(MED)治疗腰椎间盘突出症(LDH)的临床疗效。方法回顾分析2017年1月至2019年1月在湖北省宜昌市中心人民医院脊柱外科住院治疗的80例单节段LDH患者的病历资料。采用数字表法随机选取40例患者接受PELD手术治疗,余40例接受MED手术治疗。对比两组患者手术切口长度、手术时间、术中透视次数、术后切口渗出时间、住院时间、住院费用及术前、出院当天、术后1个月腰背部疼痛的视觉模拟评分(VAS)。结果PELD组患者手术切口长度及术后切口渗出时间短于MED组,但MED组术中透视次数少于PELD组,差异均有统计学意义[(0.81±0.34)cm比(1.94±0.25)cm,(90.0±26.1)min比(87.8±18.8)min,(16.3±1.34)次比(3.8±0.56)次,均P<0.05];但两组患者手术时间及住院费用差异均无统计学意义(均P>0.05);同时,两种手术方式均能很好地缓解LDH患者疼痛症状,差异无统计学意义(P>0.05)。结论PELD与MED治疗LDH均有显著临床疗效,但两种手术方式各有优势,需严格把握其适应证。

Objective To analyze and compare the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in the treatment of lumbar disc herniation (LDH) and clinical outcomes. Methods Retrospective study subjects of 80 patients with single- segment LDH were selected in Department of Spinal Surgery, Yichang Central People's Hospital from January 2017 to January 2019, including 40 patients who received PELD surgery and the remaining 40 patients who received MED surgery. The operative incision length, operative time, postoperative incision exudation, length of stay, and visual analogue scale (VAS) for low back pain of the incision pre-operation and on the day of discharge and one month after operation were compared between the 2 groups. Results The length of surgical incision and the number of days of postoperative incision exudation in the PELD group were less than that in the MED group, but the number of intraoperative fluoroscopy in the MED group was less than that in the PELD group, with statistically significant differences [(0.81±0.34)cm vs (1.94±0.25)cm,( 90.0 ±26.1)min vs (87.8± 18.8)min ,(16.3±1.34)times vs (3.8±0.56)times,all P <0.05 ]. However, there was no significant difference in operation time and hospitalization cost between the 2 groups ( P > 0.05). At the same time, both surgical methods could well solve the pain symptoms of LDH patients , but the difference was not statistically significant ( P >0.05). Conclusion PELD and MED have significant clinical efficacy in the treatment of LDH, but 2 kinds of operation have their own advantages , and their indications should be strictly controlled.