两种入路椎间孔镜手术治疗初次单节段腰椎间盘突出症

Two kinds of approaches transforaminal endoscopic surgery in the treatment of single segment lumbar disc herniation for the first treatment

目的探讨经皮椎间孔入路和经皮椎板间入路椎间孔镜手术治疗初次单节段腰椎间盘突出症的疗效。方法将106例行椎间孔镜手术治疗的单节段腰椎间盘突出症患者以随机数字表法分为A组(经皮椎间孔入路,53例)和B组(经皮椎板间入路,53例)。比较两组手术时间、术中X线透视次数、术后卧床时间、术后住院时间、手术前后VAS评分和ODI评分、术后并发症发生率以及临床疗效。结果患者均获得12个月随访。手术时间和术中透视次数B组均显著短(少)于A组(P<0.05)。术后卧床时间B组显著长于A组(P<0.05)。两组住院时间比较差异无统计学意义(P>0.05)。两组术后VAS评分和ODI评分均显著低于术前(P<0.05);两组间比较差异无统计学意义(P>0.05)。术后12个月,两组临床疗效比较差异无统计学意义(P>0.05)。术后并发症发生率B组高于A组(P<0.05)。结论两种入路椎间孔镜手术治疗初次单节段腰椎间盘突出症总体疗效接近,经皮椎间孔入路椎间孔镜手术可缩短术后卧床时间,降低术后并发症发生风险;而经皮椎板间入路椎间孔镜手术则有助于降低操作难度,减少X线透视次数。

Objective To investigate the effect of transforaminal endoscopic surgery with percutaneous transdermal intervertebral foramen approach and percutaneous interlaminar approach in the single segment lumbar disc herniation for the first treatment.Methods The 106 patients with single segment lumbar disc herniation for the first treatment were divided into two groups,including group A(53 patients adopting percutaneous transforaminal endoscopic surgery with percutaneous transdermal intervertebral foramen approach)and group B(53 patients adopting transforaminal endoscopic surgery with percutaneous interlaminar approach);and the operation time,the frequency of X-ray fluoroscopy,the time in bed after operation,the postoperative hospitalization time,the pain VAS,ODI score before and after operation,the incidence rate of postoperative complications and clinical effects of both groups were compared.Results All patients were followed up for 12 months.The operation time and the frequency of X-ray fluoroscopy of group B were significantly shorter(less)than group A(P<0.05).The time in bed after operation of group B was significantly longer than group A(P<0.05).There was no significant difference in the postoperative hospitalization time between two groups(P>0.05).The pain VAS and the ODI score after treatment were significantly lower than those before treatment(P<0.05).There were no significant differences in the pain VAS and the ODI score after treatment between two groups(P>0.05).At 12 months postoperation,there was no significant difference in the clinical effects between two groups(P>0.05).The incidence rate of postoperative complications of group B was significantly higher than group A(P<0.05).Conclusions Transforaminal endoscopic surgery with two kinds of approaches in the treatment of single segment lumbar disc herniation for first treatment possess have the similar clinical effects.Transforaminal endoscopic surgery with percutaneous transdermal intervertebral foramen approach application can efficiently shorten the time in bed after operation and reduce the risk of postoperative complications;but percutaneous interlaminar approach application should be helpful to reduce the difficulty of operation and decrease the number of X-ray fluoroscopy.