经皮椎间孔镜椎间盘切除术与经椎间孔椎体间融合术治疗腰椎间盘突出合并椎管狭窄症疗效对比研究

Comparative study on the efficacy of percutaneous transforaminal endoscopic discectomy and transforaminal lumbar interbody fusion in treatment of lumbar disc herniation combined with spinal stenosis

目的:比较经皮椎间孔镜椎间盘切除术与经椎间孔椎体间融合术治疗腰椎间盘突出合并椎管狭窄症的疗效。方法:选取80例腰4/5椎间盘突出合并椎管狭窄症患者,按照手术方式不同分为A组(41例)和B组(39例)。A组采取经皮椎间孔镜椎间盘切除术治疗,B组采取经椎间孔椎体间融合术治疗。比较两组患者围手术期指标、治疗前后Oswestry功能障碍指数(ODI)评分和治疗前后日本骨科学会(JOA)评分以及临床疗效。结果:A组手术切口长度、手术时间、住院时间以及恢复日常生活时间均明显优于B组(均P<0.05)。手术前,两组患者ODI评分比较无统计学差异(P>0.05),而在手术后不同时间段内A组ODI评分均明显低于B组(均P<0.05)。手术前,两组患者JOA评分比较无统计学差异(P>0.05),而在术后不同时间段内A组JOA评分均明显高于B组(均P<0.05)。A组优良率明显高于B组(92.68%与73.68%)(P<0.05)。结论:对腰椎间盘突出合并椎管狭窄症患者采取经皮椎间孔镜椎间盘切除术治疗,不仅具有创伤小、恢复快以及住院时间短等优点,疗效也更显著。

Objective:To compare the efficacy of percutaneous transforaminal endoscopic discectomy and transforaminal lumbar interbody fusion in the treatment of lumbar disc herniation combined with spinal stenosis.Methods:80 cases of lumbar 4/5 disc herniation combined with spinal stenosis were selected and divided into group A(41 cases)and group B(39 cases)according to different surgical methods.Group A was treated with percutaneous transforaminal endoscopic discectomy,and group B was treated with transforaminal lumbar interbody fusion.The perioperative indicators,ODI score and JOA score before and after treatment,and clinical efficacy were compared between the two groups.Results:The incision length,operation time,hospital stay and recovery time of daily life in group A were significantly better than those in group B(all P<0.05).Before operation,there was no significant difference in ODI score between the two groups(P>0.05),but ODI scores at different time after operation in group A were significantly lower than those in group B(all P<0.05).Before operation,there was no significant difference in JOA score between the two groups(P>0.05),but the JOA scores at different time after operation in group A were significantly higher than those in group B(all P<0.05).The excellent and good rate of group A was significantly higher than that of group B(92.68%vs.73.68%)(P<0.05).Conclusion:Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation combined with spinal stenosis has the advantages of less trauma,faster recovery and shorter hospital stay,and the curative effect is more significant.