两种入路椎间孔镜技术治疗巨大腰椎间盘突出症的比较

Percutaneous endoscopic discectomy for massive lumbar disc herniation through transforaminal approach versus interlaminar approach

[目的]分析比较椎间孔入路与椎板间入路两种椎间孔镜技术治疗巨大腰椎间盘突出症的临床疗效。[方法]回顾本院2016年7月~2018年1月采用椎间孔镜技术治疗的单间隙巨大腰椎间盘突出症患者25例,12例采用椎间孔入路,其余为椎板间入路。记录两组围手术期资料,采用视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)和影像检查评估临床疗效。[结果]25例患者均完成手术。术中无血管、内脏及硬膜损伤,经椎板间组1例术后出现肌力下降,经处理后恢复。经椎间孔组在手术时间、透视次数方面明显大于经椎板间组(P<0.05),两组切口长度和术后下地时间差异无统计学意义(P>0.05)。所有患者切口均一期愈合,无感染等并发症。随访6~16个月,随时间推移,两组患者VAS和ODI评分均显著减少(P<0.05),但相同时间点两组间VAS和ODI评分的差异均无统计学意义(P>0.05)。椎板间组1例男性患者术后2年因腰部外伤导致L5/S1椎间盘突出症复发,行椎间孔入路翻修手术。影像方面,术后两组患者椎管占位率和椎间隙高度均较术前显著降低(P<0.05),腰椎前凸角与腰椎Pfirrmann分级均无显著改变(P>0.05)。相同时间点,两组在椎管占位率、椎间隙高度、腰椎前凸角和腰椎Pfirrmann分级的差异均无统计学意义(P>0.05)。[结论]两种手术入路治疗巨大腰椎间盘突出症均可获得较好的临床效果,应依据具体情况选择手术入路。

Objectives versus percutaneous endoscopic interlaminar discectomy(PEID)for treatment of massive lumbar disc herniation.[Methods]A retrospective study was conducted on 25 patients who underwent percutaneous endoscopic discectomy for single-segment massive lumbar disc herniation from July 2016 to January 2018.In term of the approach applied,12 patients received PETD,while the other 13 patients had PEID.The perioperative data were documented and compared,and clinical consequences were evaluated by using visual analogue scale(VAS)for leg pain,Oswestry disability index(ODI)and imaging examination.[Results]All of the 25 patients had operation performed successfully.No vascular,visceral and dural injuries were detected in any patient.One patient in the PEID group showed decreased muscle strength after surgery,but recovered after treatment.The operative time and the number of fluoroscopy in the PETD group were significantly higher than that in the PEID group(P<0.05).There was no significant difference between the two groups in incision length and postoperative time to walk(P>0.05).All the patients had primary incision healing without infection,and were followed up for 6~16 months.The VAS and ODI scores significantly decreased over time in both group(P<0.05),although no statistically significant differences were noted between the two group at any matching time point(P>0.05).One patient in the PEID group received revision PETD at 2 years after the primary operation due to recurrence of disc prolapse secondary to a trauma.Regarding imaging assessment,the occupied ratio of spinal canal significantly decreased,meanwhile the height of in-tervertebral space also significantly declined(P<0.05),whereas the lumbosacral lordotic angle and the Pfirrmann grade for disc degeneration on MRI remained unchanged(P>0.05)after operation compared with those before operation.[Conclusions]Both PETD and PEID for the treatment of massive lumbar disc herniation do achieve good clinical results,but the indications should be reasonably selected based on the concrete clinical setting.