侧后入路经皮椎间孔镜手术治疗腰椎间盘突出症的临床效果

Effect of endoscopic lumbar discectomy via lateral posterior approach in the treatment of lumbar disc herniation

目的探讨侧后入路经皮椎间孔镜手术(PELD)治疗腰椎间盘突出症(LDH)的临床效果。方法回顾性分析2018年7月至2020年6月于洛阳市第一人民医院接受PELD治疗且接受6个月随访的97例LDH患者的临床资料,根据患者手术入路方式分为侧后入路组(48例,侧后入路PELD)与椎板间入路组(49例,椎板间入路PELD);统计并比较两组疗效、围术期指标、疼痛程度、腰椎功能及术后并发症发生情况。结果两组整体手术疗效、总有效率比较,差异未见统计学意义(P>0.05);侧后入路组手术用时长于椎板间入路组,术后卧床时间、总住院时间短于椎板间入路组(P<0.05);两组随访结束时视觉模拟法(VAS)评分、腰椎Oswestry功能障碍指数(ODI)评分均低于术前(P<0.05);两组术前、随访结束时VAS评分、ODI评分比较,差异未见统计学意义(P>0.05);侧后入路组并发症总发生率低于椎板间入路组(P<0.05)。结论LDH患者经侧后入路PELD治疗效果较好,患者术后疼痛程度减轻、腰椎功能改善,且相比椎板间入路,可缩短术后卧床与住院时间,减少并发症发生,但手术时间较长。

Objective To investigate the clinical effect of percutaneous endoscopic lumbar discectomy(PELD)via lateral posterior approach in the treatment of lumbar disc herniation(LDH).Methods The data of 97 cases of LDH who received PELD treatment and 6 months follow-up from July 2018 to June 2020 in Luoyang First People’s Hospital were collected.According to different surgical approaches of patients,they were divided into lateral posterior approach group(48 cases,PELD through lateral posterior approach)and interlaminar approach group(49 cases,PELD through interlaminar approach).The surgical efficacy,perioperative indexes,pain degree,lumbar function and postoperative complications were counted and compared between the two groups.Results There was no statistical significant difference in the overall surgical efficacy and total effective rate between the two groups(P>0.05);the operation time of the lateral posterior approach group was longer than that of the interlaminar approach group,and the postoperative bed rest time and total hospital stay were shorter than those of the interlaminar approach group(P<0.05);visual analogue scale(VAS)and Oswestry disability index(ODI)scores of both groups at the end of follow-up were lower than those before operation(P<0.05);there was no statistical significant difference in VAS and ODI scores between the two groups before operation and at the end of follow-up(P>0.05);the total incidence of complications in the lateral posterior approach group was lower than that in the interlaminar approach group(P<0.05).Conclusions The PELD treatment effect of LDH patients via the lateral posterior approach is better,the postoperative pain is reduced,the lumbar function is improved,and compared with the interlaminar approach,it can shorten the postoperative bed and hospitalization time,reduce the occurrence of complications,but the operation time is longer.