经皮内窥镜下腰椎间盘切除术与微创经椎间孔腰椎椎体间融合术治疗单节段腰椎间盘突出症的效果比较

Comparison of effects of percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion in the treatment of single segment lumbar disc herniation

目的比较经皮内窥镜下腰椎间盘切除术(PELD)和微创经椎间孔腰椎椎体间融合术(MIS-TLIF)治疗单节段腰椎间盘突出症(LDH)的效果。方法回顾性分析2019年11月至2020年10月我院诊治的55例单节段LDH患者的临床资料,根据手术方式将患者分为PELD组(30例)和MIS-TLIF组(25例)。比较两组的围术期指标、疼痛和腰椎功能障碍评分、影像学指标、术后并发症发生情况。结果PELD组的手术时间、住院时间短于MIS-TLIF组,术中出血量、术后引流量少于MIS-TLIF组(P<0.05)。术后1个月,两组的VAS、ODI评分均较术前显著降低,且PELD组低于MIS-TLIF组(P<0.05)。术前及术后1、3个月,两组的椎间隙高度指数、病变节段ROM无显著差异(P>0.05);术后6个月,PELD组的椎间隙高度指数显著小于MIS-TLIF组,病变节段ROM显著大于MIS-TLIF组(P<0.05)。两组的术后并发症总发生率无显著差异(P>0.05)。结论PELD、MIS-TLIF治疗单节段LDH各有优劣,PELD手术时间短、术中创伤小,更利于术后恢复;MIS-TLIF后期可较好地维持椎间隙高度及病变节段ROM。

Objective To compare the effects of percutaneous endoscopic lumbar discectomy(PELD)and minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)in the treatment of single segment lumbar disc herniation(LDH).Methods The clinical data of 55 patients with single segment LDH treated in our hospital from November 2019 to October 2020 were analyzed retrospectively.According to the operation method,the patients were divided into PELD group(30 cases)and MIS-TLIF group(25 cases).The perioperative indexes,pain and lumbar dysfunction scores,imaging indexes and postoperative complications were compared between the two groups.Results The operation time and hospital stay in the PELD group were shorter than those in the MIS-TLIF group,and the amount of intraoperative bleeding and postoperative drainage in the PELD group were less than those in the MIS-TLIF group(P<0.05).One month after operation,the VAS and ODI scores of the two groups were significantly lower than those before operation,and those in the PELD group were lower than the MIS-TLIF group(P<0.05).There were no significant differences in intervertebral space height index and ROM of diseased segments between the two groups before operation and on 1 and 3 months after operation(P>0.05);on 6 months after operation,the intervertebral space height index in the PELD group was significantly lower than that in the MIS-TLIF group,and the ROM of diseased segments was significantly higher than that in the MIS-TLIF group(P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion PELD and MIS-TLIF in the treatment of single segment LDH have their own advantages and disadvantages.PELD has short operation time and less intraoperative trauma,which is more conducive to postoperative recovery;MIS-TLIF can maintain the intervertebral space height and ROM of diseased segments in the later stage.