PETD与Endo-Surgical治疗L4、5椎间盘突出症的疗效比较

Comparison of clinical efficacy between endoscopic surgical approach and conventional percutaneous endoscopic transforaminal discectomy approach for L disc herniation

目的比较脊柱内镜下外科入路手术(Endoscopic surgical approach,Endo-Surgical)与经皮内镜椎间孔入路椎间盘切除术(Percutaneous endoscopic transforaminal discectomy,PETD)治疗L4、5椎间盘突出症的临床疗效。方法回顾性分析自2018-01—2018-11诊治的90例腰椎间盘突出症,63例采用Endo-Surgical术治疗(Endo-Surgical组),27例采用PETD术治疗(PETD组),比较2组手术时间、术中透视次数及术后1、3、6个月ODI指数、疼痛VAS评分。结果 90例均顺利完成手术并获得至少6个月的随访。PETD组出现暂时性下肢症状加重1例,早期复发腰椎间盘突出症1例。Endo-Surgical组早期复发腰椎间盘突出症1例。Endo-Surgical组手术时间、术中透视次数较PETD组少,差异有统计学意义(P<0.05)。2组术后1、3、6个月ODI指数与疼痛VAS评分比较差异无统计学意义(P>0.05)。结论 Endo-Surgical与PETD治疗L4、5椎间盘突出症均可以取得满意疗效,但Endo-Surgical可以显著减少手术时间与术中透视次数。

Objective To compare the clinical efficacy between endoscopic surgical approach(Endo-Surgical) and percutaneous endoscopic transforaminal discectomy(PETD) approach in the treatment of L4、5 disc herniation.Methods Ninety cases of lumbar disc herniation diagnosed and treated from January 2018 to November 2018 were retrospectively analyzed, 63 cases were treated with Endo-Surgical surgery(Endo-Surgical group), and 27 cases with PETD surgery(PETD group). The operative time, radiation exposure, pain VAS score and ODI score at 1 month, 3 months and 6 months after surgery were compared in the two groups.ResultsAll patients in the two groups underwent the operation successfully and were followed up for at least 6 months. There were 1 case of temporary lower extremity symptoms and 1 case of early recurrence in the PETD approach group.There was 1 case of early recurrence in the Endo-Surgical approach group. The operative time and radiation exposure in the Endo-Surgical approach group were significantly less than those in the PETD approach group(P<0.05). There was no significant difference in pain VAS score and ODI score at 1 month, 3 months and 6 months after surgery between the two groups(P>0.05).Conclusion Both the Endo-Surgical approach and the PETD approach can treat L4、5 disc herniation satisfactorily. Endo-Surgical approach could significantly reduce the operative time and radiation exposure.