两种方法治疗腰椎间盘突出症的疗效比较

Effect comparison of two methods in the treatment of lumbar disc herniation

目的比较显微内窥镜下椎间盘切除术(MED)和经皮椎间孔镜下椎间盘切除术(PTED)治疗腰椎间盘突出症的临床疗效。方法将96例单节段腰椎间盘突出患者按治疗方法不同分为MED组(48例,采用MED治疗)和PTED组(48例,采用PTED治疗)。比较两组手术情况,采用疼痛VAS评分及改良MacNab标准评价疗效。结果手术时间和住院费用PTED组长(多)于MED组(P<0.05)。住院时间两组比较差异无统计学意义(P>0.05)。术后并发症MED组2例、PTED组3例。患者均获得6个月随访。VAS评分:两组术后第1天均较术前明显降低(P<0.05),两组术后第1天比较差异无统计学意义(P>0.05)。术后3个月采用改良MacNab标准评价临床疗效:MED组优良率为87.50%,PTED组优良率为89.58%,两组优良率比较差异无统计学意义(P>0.05)。结论MED和PTED治疗腰椎间盘突出症均有良好的效果,MED手术时间短、住院费用低,但PTED更微创。

Objective To compare the effect of microendoscopy discectomy discectomy(MED)and percutaneous transforaminal endoscopic discectomy(PTED)for treatment of lumbar disc herniation.Methods The 96 cases with single segment lumbar disc herniation were divided into MED group(adopting MED treatment)PTED group(adopting PTED treatment),according to different treatment method,with 48 patients in each group.The surgery situation in the two groups were compared,and the postoperative clinical efficacy was evaluated by pain visual analogue score(VAS)and improved MacNab criteria.Results The operation time and hospitalization cost of the PTED were longer(higher)than those of MED group(P<0.05).There was no significant difference in hospitalization time between the two groups(P>0.05).Postoperative complications:there were 2 cases of MED group,3 cases of PTED group.All patients were followed up for 6 months.VAS:at postoperative 1 d,which was significantly decreased than the preoperation(P<0.05),and there was no statistical difference at postoperative 1 d(P>0.05).At postoperative 3 months,the excellent-good rate of Modified MacNab criteria:MED group was 87.50%,and PTED group was 89.58%,there was no statistically significant difference for excellent-good rate between two group(P>0.05).Conclusions Both of MED and PTED are good effect in the treatment of lumbar disc herniation,MED has shorter operation time and lower hospitalization cost,while PTED is more minimally invasive.