不同入路内镜下治疗腰5/骶1椎间盘突出症的临床效果

Clinical efficacy of endoscopic procedure via different approaches for treating lumbar vertebra 5/sacral vertebra 1 lumbar disc herniation

目的比较经椎间孔入路及椎板间入路内镜下治疗腰5/骶1椎间盘突出症的临床效果。方法将243例腰5/骶1椎间盘突出症患者随机分为经皮内镜经椎间孔椎间盘切除术(PETD)组(n=117)与经皮内镜椎板间髓核摘除术(PEID)组(n=126)。比较两组手术时间、C型臂X线照射次数及手术相关并发症的发生情况。于术前及末次随访时评估患者的疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI),并于末次随访时进行MacNab腰椎功能评估。结果PEID组的手术时间、C臂投照次数均少于PETD组(均P<0.05),但两组的并发症发生率差异无统计学意义(P>0.05)。两组末次随访时的VAS评分及ODI均较术前降低(均P<0.05),但组间差异无统计学意义(均P>0.05);PETD组、PEID组的MacNab腰椎功能优良率分别为94.0%(110/117)、93.7%(118/126),两组差异无统计学意义(P>0.05)。结论PEID及PETD均是治疗腰5/骶1椎间盘突出症安全、有效的微创方法,各有利弊,术者应该根据自身临床经验及患者的实际情况个性化选择手术入路。

Objective To compare clinical efficacy between transforaminal and intervertebral endoscopic procedures for treating lumbar vertebra 5/sacral vertebra 1(L 5/S 1)lumbar disc herniation.Methods A total of 243 patients with L 5/S 1 lumbar disc herniation were randomly divided into percutaneous endoscopic transforaminal discectomy(PETD)group(n=117)and percutaneous endoscopic interlaminar discectomy(PEID)group(n=126).Operation duration,radiation frequency of C-arm X-ray,and incidence of surgery-related complications were compared between the two groups.Before operation and at the last follow-up,the Visual Analogue Scale(VAS)pain score and Oswestry Disability Index(ODI)of the patients were assessed,besides,the MacNab lumbar function was evaluated at the last follow-up.Results The PEID group had shorter operation duration and less radiation frequency of C-arm X-ray compared with the PETD group(all P<0.05),but no statistically significant difference was found in incidence rate of complications between the two groups(P>0.05).The VAS score and ODI at the last follow-up were lower than the preoperative in both groups(all P<0.05),but exhibiting no statistically significant difference between groups(all P>0.05);the excellence and good rates of the MacNab lumbar function in the PETD group and the PEID group were 94.0%(110/117)and 93.7%(118/126),respectively,showing no statistically significant difference between the two groups(P>0.05).Conclusion Either PEID or PETD is a safe,effective and minimally invasive therapy for L 5/S 1 lumbar disc herniation,having its own advantages and disadvantages.Therefore,the surgeon should choose a personalized surgical approach according to his own clinical experience and patients′actual situation.