经椎间孔与经椎板间内镜治疗腰椎间盘重度脱出

Percutaneous endoscopic transforaminal discectomy versus translaminar counterpart for severely migrated lumbar disc prolapse

[目的]比较经椎间孔与经椎板间内镜治疗重度脱出型腰椎间盘突出症的临床疗效。[方法] 2018年1月—2019年1月本院收治重度脱出型腰椎间盘突出症患者60例,随机分为两组。其中,30例采用经椎间孔内镜术,30例采用经椎板间内镜术。比较两组围手术期、随访及影像资料。[结果]经椎间孔组有3例因术中无法完成手术而退出,最终共57例患者纳入结果分析。两组切口长度、切除髓核体积、下地行走时间、早期并发症、住院时间比较差异均无统计学意义(P> 0.05)。经椎板间组手术时间、术中失血量和透视次数均显著优于经椎间孔组(P<0.05)。随访12~15个月,随时间推移,两组VAS和ODI评分显著降低(P<0.05),而JOA评分均显著增加(P<0.05),但相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时两组椎间隙高度均显著降低(P<0.05),而腰椎前凸角无显著改变(P>0.05)。相同时间点两组在椎间隙高度、腰椎前凸角的差异均无统计学意义(P>0.05)。[结论]经椎间孔入路和经椎板间入路治疗重度脱出型腰椎间盘突出症均能取得较好的临床疗效,椎板间入路更具有优势。

[Objective] To compare the clinical efficacy of percutaneous endoscopic transforaminal discectomy(PETD) versus percutaneous endoscopic interlaminar discectomy(PEID) for severely prolapsed lumbar disc herniation. [Methods] A total of 60 patients who admitted to our hospital from January 2018 to January 2019 for severely migrated lumbar disc prolapse were randomly divided into two groups.Among them, 30 patients were undergoing PETD, while the other 30 patients were undergoing PEID. The perioperative, follow-up and imaging data of the two groups were compared. [Results] In the PETD group, 3 patients were withdrawn from this study due to unable complete of the operation on plan, therefore a total of 57 patients were included in the study finally. Although there were no significant differences between the two groups in terms of incision length, volume of nucleus pulposus resected, ambulation time, early complications and hospital stay between the two groups(P<0.05), the PEID group proved significantly superior to the PETD group in terms of operation time, intraoperative blood loss and fluoroscopy times(P<0.05). The VAS scores for low back pain and leg pain, as well as ODI scores decreased significantly(P<0.05), whereas JOA scores increased significantly in both groups over time(P<0.05). However, there was no statistically significant difference between the two groups in aforesaid scores at any matching time points(P>0.05). Radiographically, the height of the intervertebral space significantly declined(P<0.05), while lumbar lordosis angle remained unchanged significantly(P>0.05) in both groups at the latest follow up compared with those preoperatively. There were no significant differences in intervertebral height and lumbar lordosis angle between the two groups at any corresponding time points(P>0.05). [Conclusion] Both PETD and PEID are effective for treatment of severely prolapsed lumbar disc herniation, by comparison, the PEID takes more advantages.