经皮椎间孔镜与椎板开窗髓核摘除术治疗中年腰椎间盘突出症的效果比较

Comparison of effects of percutaneous transforaminal endoscopic discectomy and fenestration discectomy on middle-aged lumbar disc herniation

目的分析经皮椎间孔镜髓核摘除术(PTED)与椎板开窗髓核摘除术治疗中年腰椎间盘突出症的效果。方法抽取2016年1月至2020年12月南阳南石医院收治的中年腰椎间盘突出症患者126例,按照随机数字表法分为A组和B组,每组63例。A组采用PTED,B组采用椎板开窗髓核摘除术。比较两组优良率、围术期指标、运动障碍、疼痛反应、神经疼痛因子[神经肽Y(NPY)、神经生长因子(NGF)]。结果A组优良率(96.83%,61/63)高于B组(82.54%,52/63),P<0.05。A组住院天数、卧床时间短于B组,且手术出血量少于B组(P<0.05)。A组术后3 d疼痛反应评分低于B组,A组术后1个月运动障碍评分低于B组(P<0.05)。术后3 d,A组NPY、NGF水平低于B组(P<0.05)。结论与椎板开窗髓核摘除术相比,采用PTED治疗中年腰椎间盘突出症,可提高优良率,减少手术出血量,降低疼痛因子表达、减轻疼痛度,加快术后恢复,改善功能障碍。

Objective To analyze the effect of percutaneous transforaminal endoscopic discectomy(PTED)and fenestration discectomy in the treatment of middle-aged lumbar disc herniation.Methods A total of 126 cases of middle-aged lumbar disc herniation treated in Nanshi Hospital of Nanyang from January 2016 to December 2020 were selected,and they were divided into group A and group B according to random number table method,with 63 cases in each group.Both groups received nucleus pulposus removal,moreover,group A was treated by PTED and group B was treated by fenestration discectomy.The excellent and good rates,perioperative indexes,dyskinesia,pain response,nerve pain factors including neuropeptide Y(NPY)and nerve growth factor(NGF)were compared between the two groups.Results The excellent and good rate of the group A(96.83%,61/63)was higher than that of group B(82.54%,52/63),P<0.05.The number of hospitalization days and time in bed in the group A were shorter than those in the group B,and the intraoperative blood volume in the group A was less than that in the group B(P<0.05).The 3-day postoperative pain response score of the group A was lower than that of the group B,and the 1-month postoperative dyskinesia score of the group A was lower than that of the group B(P<0.05).The levels of NPY and NGF in the group A were lower than those in the group B 3 days after operation(P<0.05).Conclusions Compared with fenestration discectomy,PTED for middle-aged patients with lumbar disc herniation can improve the excellent and good rate,reduce the intraoperative blood volume,reduce the expression of pain factors,relieve pain,speed up postoperative recovery,and improve dysfunction.