两种入路内镜椎间盘切除术的比较

Comparison of two approaches for endoscopic discectomy of lumbar disc herniation

[目的]比较经椎间孔入路与经椎板间入路内镜椎间盘切除术治疗椎间盘突出症(lumbar disc herniation,LDH)的临床效果。[方法]2018年1月-2019年1月,采用内镜椎间盘切除术治疗LDH患者66例。依据术前医患沟通结果,33例采用经椎间孔入路,33例采用经椎板间入路。比较两组围术期、随访与影像资料。[结果]两组患者均顺利手术。椎间孔组手术时间和术中透视次数均显著高于椎板间组(P<0.05);但是两组术中失血量、切口长度、术后下地时间、住院时间的差异均无统计学意义(P>0.05)。并发症率椎间孔组为6.06%(2/33),椎板间组为3.03%(1/33),两组间差异无统计学意义(P>0.05)。两组患者术后随访12~24个月,平均(16.82±7.12)个月。随时间推移,两组患者的VAS评分和ODI评分均显著下降(P<0.05);相应时间点,两组间VAS和ODI评分的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时,两组椎管占位率均显著下降(P<0.05),但是,椎间隙高均无显著变化(P>0.05)。相应时间点,两组间椎管占位率和椎间隙高度的差异均无统计学意义(P<0.05)。[结论]与经椎间孔入路相比,经椎板间入路手术时间短、术中伤椎透视次数少,但两种脊柱内镜术治疗LDH确切疗效。

[Objective]To compare the clinical results of endoscopic discectomy through the transforaminal approach versus interlaminar approach for lumbar disc herniation(LDH).[Methods]From January 2018 to January 2019,66 patients underwent endoscopic discectomy for LDH.According to the results of preoperative doctor-patient communication,33 cases had operation performed through transforaminal approach,while the remaining 33 cases were operated on through the interlaminar approach.The patients in two groups were compared regarding the perioperative,follow-up and imaging data.[Results]All patients in both groups were operated on successful surgery.The transforaminal group consumed significantly longer operation time,with significantly greater fluoroscopy times than the interlaminar group(P<0.05),although there were no statistical differences between the two groups in terms of blood loss,incision length,time to return walking postoperatively and hospital stay(P>0.05).Complication rate was 6.06%(2/33)in the transforaminal group and 3.03%(1/33)in the interlaminar group,which was not statistically significant between the two groups(P>0.05).The patients in both groups were followed for 12 to 24 months after surgery,with an average of 7.12 months(16.82±7.12 months).The VAS and ODI scores decreased significantly in both groups over time(P<0.05),however,there were no statistically significant differences in VAS and ODI scores between the two groups at any corresponding time point(P>0.05).In terms of imaging assessment,the vertebral canal occupancy rate decreased significantly(P<0.05),while the intervertebral space height remained unchanged at the latest follow-up compared with those preoperatively in both groups(P>0.05).At the corresponding point in time,the differences between the two groups in vertebral canal occupancy rate and intervertebral space height were not statistically significant(P>0.05).[Conclusion]Endoscopic discectomy through both approaches does achieve satisfactory clinical outcomes for LDH.Compared with the transforaminal approach,the translaminar approach has advantage of shorter operation time and less intraoperative fluoroscopy.