经皮椎间孔镜TESSYS术与TLIF术治疗腰椎间盘突出症合并神经根管狭窄的疗效对比研究

A Comparative Study on the Therapeutic Effect of Percutaneous Intervertebral Foraminoscopy and TLIF in the Treatment of Lumbar Disc Herniation with Nerve Root Canal Stenosis

目的:对比经皮椎间孔镜TESSYS术与经椎间孔入路腰椎椎体间融合术(TLIF)治疗腰椎间盘突出症(LDH)合并神经根管狭窄的疗效。方法:回顾性分析2016年4月~2019年4月期间徐州医科大学附属沭阳医院收治的96例LDH合并神经根管狭窄患者的临床资料,根据手术方式的不同将患者分为A组(n=48,采用TLIF术式治疗)和B组(n=48,采用经皮椎间孔镜TESSYS术治疗),比较两组优良率、视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)、椎间高度、滑脱程度、隐神经、腓肠神经等感觉神经传导速度(SCV)和胫神经、腓总神经等运动神经传导速度(MCV),记录两组并发症发生情况。结果:B组优良率高于A组(P<0.05)。两组患者术后6个月VAS评分、ODI评分以及滑脱程度均降低,且B组低于A组(P<0.05)。两组患者术后6个月椎间高度、隐神经SCV、腓肠神经SCV、胫神经MCV、腓总神经MCV升高,且B组高于A组(P<0.05)。B组并发症发生率低于A组(P<0.05)。结论:与TLIF术式相比,经皮椎间孔镜TESSYS术治疗LDH合并神经根管狭窄的疗效显著,可有效减轻患者疼痛,提高腰背功能,明显改善双下肢神经功能,提高筋膜代偿能力,且并发症发生率更低,临床应用价值更高。

Objective:To compare the therapeutic effect of percutaneous transforaminal microsurgery(tessys)and transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar disc herniation(LDH)with nerve root canal stenosis.Methods:The clinical data of 96 patients with LDH and stenosis of nerve root canal received in Shuyang Hospital Affiliated to Xuzhou Medical University from April 2016 to April 2019 were analyzed retrospectively.According to the different operation methods,the patients were divided into two groups:group A(n=48,TLIF)and group B(n=48,transdermal endoscopic tessys).The excellent rate,visual pain simulation score(VAS),Oswestry dysfunction index(ODI),intervertebral height,degree of slippage,sensory nerve conduction velocity(SCV)of saphenous nerve,sural nerve and motor nerve conduction velocity(MCV)of tibial nerve and common peroneal nerve were compared between the two groups,and the complications of the two groups were recorded.Results:The excellent and good rate of group B was higher than that of group A(P<0.05).The vas,ODI scores and the degree of slippage of the two groups were lower than those of group A(P<0.05).The intervertebral height,saphenous nerve SCV,sural nerve SCV,tibial nerve MCV and common peroneal nerve MCV of the two groups were higher than those of group A(P<0.05).The incidence of complications in group B was lower than that in group A(P<0.05).Conclusion:Compared with TLIF,percutaneous transforaminal microsurgery(tessys)is effective in the treatment of LDH with nerve root canal stenosis.It can effectively improve the pain of patients,improve the back function,improve the nerve function of both lower limbs,and improve the ability of fascial compensation,with fewer complications,and has higher clinical application value.