经椎板间与椎间孔入路椎间孔镜手术治疗腰椎间盘突出症疗效比较

Effect of endoscopic surgery by interlaminar and transforaminal approach in the treatment of lubar intervertebral disc protrusion

目的比较经椎板间与椎间孔入路椎间孔镜手术治疗腰椎间盘突出症(LIDP)的临床效果。方法选择2014年10月至2016年10月驻马店市中心医院收治的164例LIDP患者为研究对象,所有患者行椎间孔镜手术治疗,其中131例患者采取椎板间入路(椎板间入路组),33例患者采取椎间孔入路(椎间孔入路组)。2组患者分别于术前及术后3、7、30、90 d进行视觉模拟评分法(VAS)评分和Oswestry功能障碍指数(ODI)问卷测评;术后3个月按照MacNab疗效判定标准评估2组患者的临床疗效;术后随访1~2 a,观察2组患者并发症及术后复发情况。结果与椎板间入路组比较,椎间孔入路组患者手术时间长,术中X线照射次数多,术后卧床时间短(P<0.05);2组患者术中出血量、术后住院时间比较差异无统计学意义(P>0.05)。2组患者术后3、7、30、90 d VAS评分和ODI均显著低于术前(P<0.05);术前及术后3、7、30、90 d,2组患者VAS评分及ODI比较差异均无统计学意义(P>0.05)。椎板间入路组和椎间孔入路组患者治疗效果优良率分别为96.18%(126/131)、90.90%(30/33),2组患者治疗效果优良率比较差异无统计学意义(χ^2=0.273,P>0.05)。椎板间入路组和椎间孔入路组患者术后并发症发生率分别为3.05%(4/131)、6.06%(2/33),2组患者术后并发症发生率比较差异无统计学意义(χ^2=0.092,P>0.05)。椎板间入路组和椎间孔入路组患者术后复发率分别为2.29%(3/131)、3.03%(1/33),2组患者术后复发率比较差异无统计学意义(χ^2=0.148,P>0.05)。结论经椎板间及椎间孔入路椎间孔镜手术治疗LIDP均有显著疗效,可有效缓解患者腰椎疼痛,改善患者腰椎功能。2种手术入路各有优势,应根据LIDP患者的实际情况选择更为合适的手术入路。

Objective To compare the clinical effect of endoscopic surgery by interlaminar and transforaminal approach in the treatment of lubar intervertebral disc protrusion(LIDP).Methods A total of 164 patients with LIDP admitted to Zhumadian Central Hospital from October 2014 to October 2016 were selected as the study subjects.All patients underwent endoscopic surgery,131 patients were treated by interlaminar approach(interlaminar approach group),and 33 patients were treated by transforaminal approach(transforaminal approach group).The patients in the two groups were evaluated by visual analogue scale(VAS)and Oswestry disability index(ODI)questionnaire before operation and at 3,7,30 and 90 days after operation respectively.The clinical effect was evaluated according to MacNab standard at 3 months after operation.The patients were followed up for 1-2 years,and the complications and recurrence were observed.Results Compared with the interlaminar approach group,the operation time was longer,X-ray irradiation times during operation was more and the postoperative bed-rest time was shorter in the transforaminal approach group(P<0.05).There was no significant difference in the intraoperative bleeding volume and hospitalization time between the two groups(P>0.05).The VAS score and ODI at 3,7,30 and 90 days after operation were significantly lower than those before operation in the two groups(P<0.05).There was no significant difference in the VAS score and ODI between the two groups before operation and at 3,7,30 and 90 days after operation(P>0.05).The fineness rate in the interlaminar approach group and transforaminal approach group was 96.18%(126/131)and 90.90%(30/33),respectively.There was no significant difference in the fineness rate between the two groups(χ^2=0.273,P>0.05).The incidence of postoperative complications in the interlaminar approach group and transforaminal approach group was 3.05%(4/131)and 6.06%(2/33),respectively.There was no significant difference in the incidence of postoperative complication between the two groups(χ^2=0.092,P>0.05).The recurrence rate in the interlaminar approach group and transforaminal approach group was 2.29%(3/131)and 3.03%(1/33),respectively.There was no significant difference in the recurrence rate between the two groups(χ^2=0.148,P>0.05).Conclusion The endoscopic surgery by interlaminar and transforaminal approach in the treatment of LIDP has significant effect,which can effectively alleviate lumbar pain and improve lumbar function.The two surgical approaches have their own advantages,the more suitable surgical approaches should be chosen according to the actual situation of LIDP patients.