IL-PELD与MED治疗非极外侧型腰5/骶1椎间盘突出症的临床研究

Clinical research on treatment of L5/S1 intervertebral disc herniation through IL-PELD and MED

目的比较经皮椎间孔镜下腰椎间盘髓核摘除术(IL-PELD)与经后路显微内窥镜下腰椎间盘髓核摘除术(MED)治疗非极外侧型腰5/骶1椎间盘突出症的临床疗效。方法采用随机数字表法,将2016年10月至2018年12月永川医院骨科收治入院的单节段非极外侧型腰5/骶1椎间盘突出症的患者分为IL-PELD组与MED组,比较两组手术时间、术中出血量、术中透视次数、术后卧床时间、住院时间、并发症的差异,采用术前及术后VAS评分、ODI评分、JOA评分评估患者术后恢复情况。结果IL-PELD手术时间、术中透视次数、并发症发生率高于MED组(P<0.05),而术中失血量、术后卧床时间、住院时间少于MED组(P<0.05)。两组间末次随访腰痛及腿痛VAS评分(P腰痛=0.68、P腿痛=0.53)、JOA评分(P=0.86)、ODI评分(P=0.79)差异均无统计学意义。结论退变不严重的非极外侧型腰5/骶1椎间盘突出症推荐IL-PELD。中央型椎间盘突出及退变严重的巨大椎间盘突出推荐MED。

Objective To compare the clinical efficacy of interlaminar percutaneous endoscopic lumber discectomy(IL-PELD)and microendoscopic discectomy(MED)in the treatment of the non-extreme lateral L5/S1 lumbar disc herniation.Methods The patients who were admitted to the hospital from October 2016 to December 2018 and diagnosed with single-segment non-extreme lateral L5/S1 lumbar disc herniation were divided into the IL-PELD group and the MED group by random number table method.The operation time,intraoperative bleeding volume,intraoperative fluoroscopy,postoperative bed time,hospitalization time,and complication rate were compared between the two groups.The preoperative and postoperative VAS score,ODI score,and JOA score were used to evaluate the postoperative recovery.Results The operation time,intraoperative fluoroscopy and complication rate of the IL-PELD were higher than those of the MED group(P<0.05),but the intraoperative bleeding volume,postoperative bed time and hospitalization time were less than the MED group(P<0.05).There was no significant difference in the VAS scores of low back pain and leg pain(Plow back pain=0.68,Pleg pain=0.53),JOA score(P=0.86),and ODI score(P=0.79).Conclusion It is more recommended for IL-PELD to the non-serious degenerative non-extreme lateral L5/S1 lumbar disc herniation,which for MED to the central disc herniation and serious degenerative disc herniation.