经皮椎间孔镜椎间盘切除术与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床效果比较

Comparison of the clinical effects of percutaneous transforaminal endoscopy discectomy and fenestration discectomy in the treatment of lumbar disc herniation

目的比较经皮椎间孔镜椎间盘切除术(PTED)与椎板开窗髓核摘除术(FD)治疗腰椎间盘突出症的临床效果。方法回顾性抽取2018年1月至2021年6月我院收治的88例符合纳排标准、随访资料完整的腰椎间盘突出症患者为研究对象,按照不同的治疗方法将其分为PTED组(n=44)与FD组(n=44)。PTED组采用PTED方法进行治疗,FD组采用FD方法进行治疗。比较两组的手术效果、手术相关指标、疼痛情况、腰椎功能障碍程度、脊柱稳定性及并发症发生情况。结果术后1周,PTED组的手术优良率为95.45%,显著高于FD组的81.82%(P<0.05)。PTED组的手术时间长于FD组,但切口长度、术后卧床时间、术后住院时间短于FD组,术中出血量少于FD组(P<0.05)。术后1 d、2周、3个月,两组的视觉模拟评分(VAS)均低于术前,且PTED组低于FD组(P<0.05);术后2周、3个月,两组的Oswestry功能障碍指数(ODI)均低于术前,且PTED组低于FD组(P<0.05)。术后3个月,两组的腰椎曲度、腰椎前凸角度、腰骨倾斜角均大于术前,且PTED组大于FD组(P<0.05)。PTED组的术后并发症总发生率为13.64%,显著低于FD组的22.73%(P<0.05)。结论相较于FD,PTED治疗腰椎间盘突出症具有创伤小、效果好、术后恢复快等优势,可作为治疗腰椎间盘突出症的一种理想术式。

Objective To compare the clinical effects of percutaneous transforaminal endoscopic discectomy(PTED)and fenestration discectomy(FD)in the treatment of lumbar disc herniation.Methods From January 2018 to June 2021,88 patients with lumbar disc herniation treated in our hospital who met the inclusion and exclusion criteria and had complete follow-up data were retrospectively selected as the research objects.The patients were divided into PTED group(n=44)and FD group(n=44)according to different treatment methods.The PTED group was treated with PTED method,and the FD group was treated with FD method.The operation effect,operation related indexes,pain,lumbar dysfunction degree,spinal stability and complications were compared between the two groups.Results One week after operation,the excellent and good rate of operation of the PTED group was 95.45%,which was significantly higher than 81.82%of the FD group(P<0.05).The operation time of the PTED group was longer than that of the FD group,but the incision length,postoperative bed rest time,postoperative hospital stay were shorter than those of the FD group,and the amount of intraoperative blood was less than that of the FD group(P<0.05).At 1 d,2 weeks and 3 months after operation,the visual analogue scale(VAS)score of the both groups was lower than that before operation,and that of the PTED group was lower than the FD group(P<0.05);at 2 weeks and 3 months after operation,the oswestry disability index(ODI)score of the both groups was lower than that before operation,and that of the PTED group were lower than the FD group(P<0.05).Three months after operation,lumbar curvature,lumbar lordosis angle and lumbar bone inclination angle of the both groups were greater than those before operation,and those of the PTED group were greater than the FD group(P<0.05).The total incidence of surgical complications of the PTED group was 13.64%,which was significantly lower than 22.73%of the FD group(P<0.05).Conclusion Compared with FD,PTED in the treatment of lumbar disc herniationhas the advantages of less trauma,has better effect and faster postoperative recovery.It can be use as an ideal operation in the treatment of lumbar disc herniation.