内镜与通道下腰椎间盘切除术的并发症与疗效比较

Complications and early clinical outcomes of percutaneous transforaminal endoscopic discectomy versus tubular discectomy for lumbar disc herniation

[目的]观察经椎间孔入路内窥镜与扩张通道下腰椎间盘切除术的疗效及并发症。[方法]2012年10月~2018年9月共治疗腰椎间盘突出症(Lumbar disc herniation,LDH)患者228例,采用经椎间孔内窥镜手术114例(TESSYS技术),采用扩张通道椎板间开窗椎间盘切除术114例。比较两组患者围手术期资料,并发症和随访结果,采用VAS、ODI评分评价临床疗效。[结果]术中并发症方面,共发生硬脊膜撕裂3例,内镜组1例,通道组2例;神经根急性损伤4例,内镜组3例,通道组1例;全脊髓麻醉1例,为内镜组患者;椎管内持续出血2例,两组各1例。内镜组在手术时间、切口总长度、术中失血量、术后下地时间、住院时间方面均显著优于通道组(P<0.05);但是内镜组术中透视次数显著多于通道组(P<0.05)。术后并发症方面,迟发性神经损伤2例,两组各1例;血栓性静脉炎2例,两组各1例;感染2例,两组各1例。所有患者随访12个月以上。随访过程中,复发2例,两组各1例。至末次随访时,228例患者总体并发症率为7.46%,内镜组为7.89%,通道组为7.02%,两组间差异无纹计学意义(P>0.05)。术后12个月,两组患者的腰痛VAS和腿痛VAS评分,以及ODI评分均较术前显著降低(P<0.05)。相同时间点,两组间在腰痛VAS评分、腿痛VAS评分和ODI评分的差异均无统计学意义(P<0.05)。[结论]两组患者均获得良好疗效,内镜技术具有创伤小、恢复快、手术及住院时间短等优点,内镜技术与通道技术总体并发症率相近。

[Objective]To compare the complications and early clinical outcomes of percutaneous transforaminal endoscop ic discectomy(PTED)versus tubular discectomy(TD)for lumbar disc herniation.[Methods]A total of 114 patients with lumbar disc herniation were surgically treated from October 2012 to September 2018.Of them,57 patients underwent PTED by using TESSYS technique,while the remaining 57 patients received TD.The complications,perioperative and follow-up documenta tions were compared between the two groups.The clinical outcomes were evaluated with visual analogue scale(VAS)for pain and Oswestry disability index(ODI).[Results]In term of the intraoperative complication,it did happen that dural tear in 3 pa tients,including 1 in the PTED group and 2 in the TD group;acute nerve root injury in 5 patients,3 in the PTED group and 2 in the TD group;total spinal anesthesia in 1 patient of the PTED group;and continuous intravertebral bleeding in 2 patient,1 in each group.The PTED group proved significantly superior to the TD group regarding to operation time,incision length,in traoperative blood loss,time to return ambulation and hospital stay(P<0.05),nevertheless the PTED group took more fluoros copy frequency than the TD group(P>0.05).With regard to the postoperative complications,there were delayed nerve injury in 2 patient,1 in each group;thrombotic phlebitis in 2 pa tient,1 in the PTED group and 1 in the TD group;and infec tion in 2 patients,1 in each group.To the latest follow up more than 12 months,recurrence of LDH was noticed in 2 patients,1 in each group,which were treated by revision PT ED.To sum up,the total complication rate of the 228 pa tients was of 7.46%,whereas 7.89%in the PTED group,and 7.02%in the TD group without a significant difference between the two groups(P>0.05).The VAS scores for low back pain and leg pain,as well as the ODI scores significantly decreased at the latest follow up compared with those before operation in both groups(P<0.05),although no statistically significant differ ences in aforesaid scores were found in any matching time point between the two group(P>0.05).[Conclusion]Both PTED and TD techniques are effective for LDH,especially the PTED with advantages of minimizing iatrogenic trauma,improving re covery,shortening operation time and hospital stay.However,the complications are common problems,which should pay great er attention to prevent.