经皮内镜椎板间开窗与椎间孔入路治疗腰椎间盘突出症的比较

Comparison of Percutaneous Endoscopic Fenestration Discectomy and Transforaminal Discectomy for Lumbar Disc Herniation

目的比较经皮内镜椎板间开窗椎间盘切除术(percutaneous endoscopic fenestration discectomy,PEFD)与椎间孔入路椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)治疗腰椎间盘突出症的临床疗效。方法回顾性分析2017年3月~2018年10月145例腰椎间盘突出症的临床资料,患者选择手术方式,其中PEFD 73例,PETD 72例。2组年龄、性别、手术节段、突出类型差异无统计学意义(P>0.05)。比较2组手术时间、术中出血量、术中透视次数、住院时间、手术并发症、术后卧床时间。比较2组术前、术后1个月、末次随访腰腿痛视觉模拟评分(Visual Analogue Scale,VAS)、Oswestry功能障碍指数(Oswestry Disability Index,ODI)。改良MacNab标准评估末次随访时的临床疗效。结果与PETD组相比,PEFD组手术时间短[(88.0±11.7)min vs.(111.7±14.2)min,t=-10.992,P=0.000],但透视次数多[(28.4±4.0)次vs.(7.1±1.1)次,t=44.023,P=0.000]。2组术中出血量、术后卧床时间、住院时间、并发症差异无统计学意义(P>0.05)。2组随访时间差异无统计学意义[(25.3±3.9)月vs.(24.6±2.5)月,t=1.340,P=0.183]。2组术后1个月、末次随访VAS评分、ODI均较术前明显改善(P<0.05),2组间比较差异无统计学意义(P>0.05)。末次随访改良MacNab标准优良率,PEFD组为90.4%(66/73),PETD组为87.5%(63/72)(χ^(2)=0.313,P=0.576)。结论PEFD可以取得与PETD相似的临床疗效,且可缩短手术时间。

Objective To evaluate the clinical results of percutaneous endoscopic fenestration discectomy(PEFD)and percutaneous endoscopic transforaminal discectomy(PETD)for lumbar disc herniation(LDH).Methods A total of 145 patients with LDH from March 2017 to October 2018 were retrospectively included.And the patients were divided into the PEFD group(n=73)or PETD group(n=72)according to their choice of different surgical methods.No significant differences in age,gender,surgical segment,herniation type were found between the two groups(P>0.05).The operation time,intraoperative blood loss,fluoroscopy times,and surgical complications were compared.The Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)were compared preoperatively,1 month postoperatively,and at the final follow-up between the two groups.The modified MacNab criteria at the final follow-up was used to evaluate clinical effectiveness.Results The operation time of the PEFD group was significantly shorter compared with the PETD group[(88.0±11.7)min vs.(111.7±14.2)min,t=-10.992,P=0.000].However,the fluoroscopy times of the PEFD group was significantly more than the PETD group[(28.4±4.0)times vs.(7.1±1.1)times,t=44.023,P=0.000].There were no significant differences in intraoperative blood loss,bed rest time,length of hospital stay,and complications between the two groups(P>0.05).No significant difference was found in follow-up time between the two groups[(25.3±3.9)month vs.(24.6±2.5)month,t=1.340,P=0.183].The VAS score and ODI at 1 postoperative month and finial follow-up were significantly improved over the preoperative scores in both groups(P<0.05).There were no significant differences in postoperative VAS and ODI between the two groups(P>0.05).There were no significant differences in excellent and good rate between the PEFD group(90.4%,66/73)and the PETD group(87.5%,63/72)at the final follow-up(χ^(2)=0.313,P=0.576).Conclusion PEFD has a similar clinical effect with PETD in the treatment of LDH,with less operation time.