内镜与开放手术治疗腰神经根管狭窄症比较

Comparison of endoscopic and open surgery for lumbar nerve root canal stenosis

[目的]比较经皮椎间孔镜(percutaneous transforaminal endoscopic discectomy,PTED)与传统后路减压椎间植骨融合术(posterior lumbar interbody fusion,PLIF)治疗腰神经根管狭窄症患者的临床疗效.[方法]2018年1月-2019年12月收治腰神经根管狭窄症患者57例,依据术前医患沟通结果,19例采用PTED术,38例采用传统PLIF术.比较两组围手术期、随访和影像资料.[结果]两组患者均顺利完成手术,无严重并发症.PTED组术中出血量、手术时间、切口长度、下地行走时间和住院时间均显著优于PLIF组(P<0.05),前者没有术后引流量,但术中透视次数显著多于后者(P<0.05).所有患者随访12~36个月,平均(22.67±8.83)个月.PTED组恢复完全负重时间显著早于PLIF组(P<0.05).末次随访时,两组患者ODI、VAS评分均较术前显著降低(P<0.05),PTED组的ODI和VAS-腰痛评分均显著优于PLIF组(P<0.05),但两组VAS-腿痛评分的差异无统计学意义(P>0.05).影像方面,与术前相比,末次随访时,两组患者神经根管面积和神经根管矢状径均显著增加(P<0.05),相同时间点,两组患者神经根管面积和神经根管矢状径的比较差异均无统计学意义(P>0.05).[结论]虽然PLIF也具有显著的疗效,但对于腰神经根管狭窄症患者,PTED可能更值得推荐.

[Objective]To compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy(PTED)versus posterior lumbar interbody fusion(PLIF)for single-segment lumbar nerve root canal stenosis.[Methods]A total of 57 patients with lumbar nerve root canal stenosis were admitted from January 2018 to December 2019.According to the preoperative doctor-patient communication results,19 patients were treated with PTED,while the remaining 38 patients were treated with traditional PLIF.The data regarding to perioperative period,follow-up and radiographs were compared between the two groups.[Results]The operation was successfully completed in both groups without serious complications.The PTED group proved significantly superior to the PLIF group in terms of intraoperative blood loss,operative time,incision length,time to return walking postoperatively and hospital stay(P<0.05),the former had no postoperative drainage,but the number of intraoperative fluoroscopy was significantly higher than the latter(P<0.05).All patients were followed up for 12〜36 months,with an average of(22.67±8.83)months.The PTED group resumed full weight-bearing activity significantly earlier than the PLIF group(P<0.05).The ODI and VAS scores significantly decreased at the latest follow-up in both groups compared with those preopera-tively(P<0.05).The PTED group was significantly superior to the PLIF group in ODI and VAS for low back pain scores(P<0.05),but there was no significant difference in VAS for leg pain score between the two groups at the latest follow up(P>0.05).Radiographically,the area and sagittal diameter of the nerve root canal were significantly increased in both groups at the last follow-up compared with those presurgery(P<0.05),however,there were no significant differences in nerve root canal area and sagittal diameter between 2 groups at matching time points(P>0.05).[Conclusion]Although PLIF also is considerably effective,the PTED may be more recommendable for lumbar nerve root canal stenosis.