经皮内镜椎板间与椎间孔入路椎间盘切除术治疗脱垂型腰椎间盘突出症的比较研究

Comparison of effect between percutaneous endoscopic translaminar discectomy and percutaneous endoscopic interlaminar discectomy in treatment of prolapsed disc herniation

目的比较经皮内镜椎板间入路椎间盘切除术(Percutaneous endoscopic interlaminar discectomy,PEID)和经皮内镜椎间孔入路椎间盘切除术(Percutaneous endoscopic transforaminal discectomy,PETD)治疗脱垂型腰椎间盘突出症的临床疗效。方法回顾性分析自2018-01—2020-01诊治的78例脱垂型腰椎间盘突出症,40例采用PEID治疗(PEID组),38例采用PETD治疗(PETD组),比较两组手术时间、术中透视次数、并发症发生率、腰椎间盘突出症复发率,比较两组重度脱垂型腰椎间盘突出症患者与轻度脱垂型腰椎间盘突出症患者的手术时间,比较两组术前以及术后1 d、1个月、3个月、12个月腰痛VAS评分、腿痛VAS评分、ODI指数。结果两组均顺利完成手术并获得完整随访,随访时间12~20个月,平均14.9个月。两组手术时间、并发症发生率、腰椎间盘突出症复发率比较差异无统计学意义(P>0.05)。PEID组透视次数较PETD组少,差异有统计学意义(P<0.05)。PEID组重度脱垂型患者手术时间较PETD组少,差异有统计学意义(P<0.05)。两组轻度脱垂型患者手术时间比较差异无统计学意义(P>0.05)。两组术前以及术后1 d、1个月、3个月、12个月腰痛VAS评分、腿痛VAS评分、ODI指数比较差异无统计学意义(P>0.05)。结论PETD和PEID治疗脱垂型腰椎间盘突出症均能取得较好的临床疗效,PEID透视次数更少,重度脱垂型腰椎间盘突出症采用PEID治疗的手术时间更短。

Objective transforaminal discectomy(PETD)in the treatment of prolapsed lumbar disc herniation.MethodsSeventy-eight cases of prolapsed disc herniation diagnosed and treated from January 2018 to January 2020 were retrospectively analyzed,40 cases were treated with PEID(PEID group)and 38 cases with PETD(PETD group).Operation time,X-ray fluoroscopy time,incidence of complications and recurrence rate of lumbar disc herniation were compared between the two groups.The operation time of patients with severe prolapsed lumbar disc herniation and patients with mild prolapsed lumbar disc herniation were compared between the two groups,and the low back pain VAS score,leg pain VAS score and ODI index were compared between the two groups before operation and at 1 d,1 month,3 months and 12 months after operation.ResultsBoth groups were successfully followed up for 12 to 20 months with an average of 14.9 months.There were no significant differences in operative time,complication rate and recurrence rate of lumbar disc herniation between the two groups(P>0.05).PEID group had less fluoroscopy times than PETD group,and the difference was statistically significant(P<0.05).The operation time of patients with severe prolapsed lumbar disc herniation in PEID group was less than that in PETD group,and the difference was statistically significant(P<0.05).There was no significant difference in the operative time between the two groups of patients with mild prolapsed lumbar disc herniation(P>0.05).There were no significant differences in lumbar pain VAS score,leg pain VAS score and ODI index between the two groups before operation and at 1 d,1 month,3 months and 12 months after operation(P>0.05).Conclusion Both PETD and PEID can achieve good clinical efficacy in the treatment of prolapsed lumbar disc herniation.PEID has fewer X-ray fluoroscopy times and the operation time of PEID in the treatment of severe prolapsed lumbar disc herniation is shorter.