经皮椎间孔镜髓核摘除术与经椎间孔入路椎管减压椎间植骨融合内固定术治疗腰椎间盘突出症的疗效比较

Effect of percutaneous endoscopic lumbar discectomy and transforaminal lumbar interbody fusion in treatment of lumbar disc herniation

目的:对比经皮椎间孔镜髓核摘除术(PELD)与经椎间孔入路椎管减压椎间植骨融合内固定术(TLIF)治疗腰椎间盘突出症(LDH)的疗效。方法:回顾性分析222例LDH患者的临床资料,根据手术方法的不同分为TLIF组(n=144)和PELD组(n=78)。两组均随访至术后6个月,比较两组围术期相关指标、治疗前后腰腿疼痛情况[视觉模拟评分法(VAS)]、腰椎功能[Oswesry功能障碍指数问卷表(ODI)]及随访期间并发症情况。结果:PELD组手术时间、首次下床活动时间、住院时间短于TLIF组,术中出血量少于TLIF组(P<0.05),切口长度短于TLIF组(P<0.05)。术后,两组下腰痛和腿痛VAS评分均随着时间推移而减轻,且各时间点PELD组下腰痛VAS评分均低于TLIF组(P<0.05);出院时,PELD组腿痛VAS评分低于TLIF组(P<0.05)。相较于TLIF组,PELD组术后6个月ODI及Cobb角更低(P<0.05),腰椎前屈及腰椎后伸更高(P<0.05)。PELD组总并发症发生率低于TLIF组(P<0.05)。结论:相比TLIF,PELD治疗LDH具有创伤小、恢复快的优势,有利于腰腿疼痛缓解和腰椎功能恢复,且并发症发生率更低。

Objective:To compare the efficacy of percutaneous endoscopic lumbar discectomy(PELD) and transforaminal lumbar interbody fusion(TLIF) in the treatment of lumbar disc herniation(LDH).Methods:The clinical data of 222 patients with LDH were retrospectively analyzed.According to the different surgical methods, they were divided into TLIF group(n=144) and PELD group(n=78).The two groups were followed up to 6 months after operation.The perioperative related indexesand leg pain before and after treatment [Visual simulation scoring method(VAS)] and lumbar function [Oswesry disability index(ODI)] were compared between the two groups, and the complications during the follow-up period were recorded.Results:The operation time, first ambulation time and hospitalization time in the PELD group were shorter than those in the TLIF group, the intraoperative blood loss was less than that in the TLIF group, and the incision length was shorter than that in the TLIF group(P<0.05).After operation, the VAS scores of low back pain and leg pain in both groups decreased with time, and the VAS scores of low back pain in PELD group were lower than those in TLIF group at each time point(P<0.05).At discharge, the VAS score of leg pain in PELD group was lower than that in TLIF group(P<0.05).Compared with the TLIF group, the PELD group had lower ODI and Cobb angle at 6 months after operation(P<0.05),and higher lumbar flexion and lumbar extension(P<0.05).The total complication rate of PELD group was lower than that of TLIF group(P<0.05).Conclusion:Compared with TLIF,PELD has the advantages of less trauma and faster recovery in the treatment of LDH,which is beneficial to the relief of lumbocrural pain and the recovery of lumbar function, and the incidence of complications is lower.