不同入路椎间孔镜治疗L_(5)/S_(1)椎间盘突出症的疗效

Clinical effect of inter foraminal endoscopic treatment of L_(5)/S_(1) lumbar disc herniation with different approaches

目的研究不同入路椎间孔镜治疗L_(5)/S_(1)椎间盘突出症临床疗效及随访。方法选取2014年3月—2016年5月医院收治的97例L_(5)/S_(1)椎间盘突出患者,分为经皮椎间孔入路(PETD)组(行PETD术治疗)46例和经皮椎板间入路(PEID)组(行PEID术治疗)51例,比较2组患者的手术疗效、手术时间、C型臂X线机透视次数、术中出血量、住院时间、疼痛视觉模拟评分(VAS)、功能障碍指数(ODI),记录2组患者并发症与复发情况。结果2组患者术后3年疗效比较,差异无统计学意义(P>0.05);PEID组手术时间短于PETD组,C型臂X线机透视次数少于PETD组(P<0.05);2组术中出血量、住院时间比较,差异无统计学意义(P>0.05);2组患者末次随访时VAS、ODI评分较术前均有明显下降(P<0.05);2组患者术前、末次随访VAS、ODI评分比较,差异无统计学意义(P>0.05),2组并发症发生率、复发率比较,差异无统计学意义(P>0.05)。结论PETD术、PEID术治疗L_(5)/S_(1)椎间盘突出患者,远期疗效良好,有效缓解患者症状,其中PEID术手术时间更短,透视次数少。

Objective To study the clinical effect and follow-up of foraminal endoscopy through different approaches in the treatment of L_(5)/S_(1) lumbar disc herniation(LDH).Methods A total of 97 patients with L_(5)/S_(1) LDH admitted to the hospital from March 2014 to May 2016 were divided into percutaneous endoscopic transforaminal discectomy group(PETD,46 cases)and percutaneous endoscopic interlaminar discectomy group(PEID,51 cases).The surgical efficacy,operation time,C-arm X-ray frequency,intraoperative blood loss,hospitalization time,scores of visual analogue scale(VAS)and Oswestry disability index(ODI)were compared between 2 groups,and complications and recurrence were recorded.Results There was no significant difference in curative effect at 3 year after surgery between 2 groups(P>0.05).The operation time in PEID group was shorter than that of PETD group,and times of C-arm X-ray machine fluoroscopy were fewer than those in PETD group(P<0.05).There were no significant difference in intraoperative blood loss or hospitalization time between the two groups(P>0.05).VAS and ODI scores at the last follow-up were significantly lower than those before surgery in both groups(P<0.05).There were no significant differences in VAS and ODI scores before surgery and at the last follow-up between 2 groups(P>0.05).There were no significant difference in incidence of complications or recurrence rate between 2 groups(P>0.05).Conclusion PETD and PEID in the treatment of patients with L_(5)/S_(1) LDH,have good long-term efficacy and can effectively relieve the symptoms.The operation time of PEID is shorter,and times of fluoroscopy are fewer.