经皮椎间孔镜下TESSYS技术与显微内镜下后路腰椎间盘切除术治疗腰椎间盘突出症患者的效果比较

Comparison of effects of TESSYS technique under percutaneous transforaminal endoscopy and microendoscopic posterior lumbar discectomy in treatment of patients with lumbar disc herniation

目的:比较经皮椎间孔镜下TESSYS技术与显微内镜下后路腰椎间盘切除术(MED)治疗腰椎间盘突出症(LDH)患者的效果。方法:选取2019年8月至2021年7月佳木斯市中医医院骨科收治的116例LDH患者进行前瞻性研究,按随机数字表法将其分为研究组和对照组各58例。研究组采用经皮椎间孔镜下TESSYS技术治疗,对照组采用MED治疗,比较两组治疗优良率、围术期指标水平、手术前后疼痛程度[视觉模拟评分表(VAS)]评分、日常生活能力[Oswestry功能障碍指数(ODI)]评分、术后3个月并发症发生率和炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)]水平。结果:两组治疗优良率、手术时间和并发症发生率比较,差异均无统计学意义(P>0.05);研究组切口长度短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后1 d,两组VAS评分均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);两组ODI评分均低于术前,但组间比较,差异无统计学意义(P>0.05);术后3 d,两组TNF-α、IL-1β水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05)。结论:采用经皮椎间孔镜下TESSYS技术与MED治疗LDH患者的效果及安全性相当,但经皮椎间孔镜下TESSYS技术可降低围术期指标和炎性因子水平,效果优于MED治疗。

Objective: To compare effects of TESSYS technique under percutaneous transforaminal endoscopy and microendoscopic posterior lumbar discectomy(MED) in treatment of patients with lumbar disc herniation(LDH). Methods: A prospective study was conducted on 116patients with LDH admitted to the Department of Orthopedics of Jiamusi Hospital of Traditional Chinese Medicine from August 2019 to July 2021.They were divided into study group and control group according to the random number table method, 58 cases in each. The study group was treated with TESSYS technique under percutaneous transforaminal endoscopy, while the control group was treated with MED. The excellent and good rate,the perioperative index levels, the pain degree [visual analogue scale(VAS)] scores before and after the surgery, the activities of daily living [Oswestry dysfunction index(ODI)] score, the incidence of complications 3 months after the surgery, and the inflammatory factor levels [tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β)] were compared between the two groups. Results: There were no significant differences in the excellent and good rate of treatment, the operation time and the incidence of complications between the two groups(P>0.05). The incision length of the study group was shorter than that of the control group, the intraoperative blood loss was less than that of the control group, and the differences were statistically significant(P<0.05). After the surgery, the VAS scores of the two groups were lower than those before the surgery, that of the study group was lower than that of the control group, and the differences were statistically significant(P<0.05). The ODI scores of the two groups were lower than those before the surgery,but there was no significant difference between the two groups(P>0.05). After the surgery, the levels of TNF-α and IL-1β in the two groups were higher than those before the surgery, but those in the study group were lower than those in the control group, and the differences were statistically significant(P<0.05). Conclusions: The efficacy and the safety of TESSYS technique under percutaneous transforaminal endoscopy and MED in the treatment of the LDH patients are comparable, but the TESSYS technique can reduce the levels of perioperative indexes and inflammatory factors.Moreover, it is superior the MED treatment.