不同手术方法治疗腰椎间盘突出症的效果比较

Comparison of the Effects of Different Methods of Surgery on Lumbar Disc Herniation

目的:比较经皮椎间孔镜(PTED)椎间盘突出髓核摘除术与常规术式后路椎板开窗减压髓核摘除术(FD)治疗腰椎间盘突出症的效果。方法:选择2015年1月-2018年7月因L4~5节段或L5~S1节段腰椎间盘突出入本院进行手术治疗的86例患者,根据手术方式不同将其分为FD组(后路椎板开窗减压髓核摘除术)和PTED组(经皮椎间孔镜椎间盘突出髓核摘除术),每组43例。比较两组的手术时间、切口长度、术后住院时间、疗效,采用视觉模拟评分(VAS)评估治疗前后患者疼痛程度,采用Oswestry功能障碍指数(ODI)评估患者腰椎功能障碍情况,采用JOA评分评估治疗前后运动功能。结果:两组的手术时间比较,差异无统计学意义(P>0.05);PTED组的切口长度、术后住院时间均显著短于FD组,差异均有统计学意义(P<0.05)。PTED组的优良率为86.05%,FD组的优良率为81.40%,两组优良率比较,差异无统计学意义(P>0.05)。两组术后24 h、1周、3个月、6个月的VAS评分均低于术前,差异均有统计学意义(P<0.05);术后6个月,PTED组VAS评分低于FD组,差异有统计学意义(P<0.05);两组术前、术后24 h、术后1周、术后3个月VAS评分比较,差异均无统计学意义(P>0.05);两组术后3、6个月ODI评分均低于术前,JOA评分均高于术前,差异均有统计学意义(P<0.05);两组术前、术后3个月、术后6个月ODI评分和JOA评分比较,差异均无统计学意义(P>0.05)。结论:PTED治疗腰椎间盘突出症的效果与FD相比无差异,但PTED手术创伤小,恢复快。

Objective:To compare the effect of percutaneous transforaminal endoscopic discectomy (PTED) with conventional fenestration discectomy (FD) for patients with lumbar disc herniation.Method:A total of 86 patients admitted to our hospital for surgical treatment due to L4-5 segment or L5-S1 segment from January 2015 to July 2018 were selected.According to different surgical methods,the patients were divided into FD group (fenestration discectomy) and PTED group (percutaneous transforaminal endoscopic discectomy),43 cases in each group.The operation time,incision length,postoperative hospital stay and efficacy of the two groups were compared.Visual analogue scores (VAS) were used to assess pain levels before and after treatment,the Oswestry dysfunction index (ODI) was used to assess the patients’ lumbar dysfunction.JOA score was used to evaluate motor function before and after treatment.Result:The operation time of the two groups was compared,the difference was not statistically significant (P>0.05).The incision length and postoperative hospital stay in the PTED group were significantly shorter than those in the FD group,the differences were statistically significant (P<0.05).The excellent rate of PTED group was 86.05%,the excellent rate of FD group was 81.40%,there was no significant difference between the two groups (P>0.05).The VAS scores of 24 hours,1 week,3 months and 6 months after surgery in the two groups were lower than those before surgery,the differences were statistically significant (P<0.05).6 months after surgery,the VAS score of PTED group was lower than that of FD group,the difference was statistically significant (P<0.05).VAS scores of the two groups were compared before surgery,24 h after surgery,1 week after surgery and 3 months after surgery,the differences were not statistically significant (P>0.05).The ODI scores of the two groups at 3 months and 6 months after the surgery were lower than those before the surgery,JOA scores were higher than those before surgery,the differences were statistically significant (P<0.05).Comparison of ODI score and JOA score between the two groups before surgery,3 months and 6 months after surgery,the differences were not statistically significant (P>0.05).Conclusion:The effect of PTED in the treatment of lumbar disc herniation is no different from that of FD,but PTED surgery has less trauma and faster recovery.