经皮椎间孔镜下髓核摘除术与经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症患者的效果比较

Comparison of effects of percutaneous transforaminal endoscopic discectomy and transforaminal lumbar interbody fusion in treatment of recurrent lumbar disc herniation

目的:比较经皮椎间孔镜下髓核摘除术与经椎间孔腰椎椎体间融合术治疗复发性腰椎间盘突出症患者的效果。方法:选取2020年4月至2021年4月该院收治的110例复发性腰椎间盘突出症患者进行前瞻性研究,按照随机数字表法分为观察组与对照组各55例。对照组采用经椎间孔腰椎椎体间融合术治疗,观察组采用经皮椎间孔镜下髓核摘除术治疗,比较两组手术时间、术中出血量、术后住院时间、Oswestry功能障碍指数问卷表(ODI)评分、疼痛视觉模拟评分法(VAS)评分、腰椎功能JOA评分和并发症发生率。结果:观察组术中出血量低于对照组,手术时间、术后住院时间短于对照组,差异有统计学意义(P<0.05);术后1周,两组ODI、VAS评分均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);术后1周、术后6个月,观察组腰椎功能日本骨科协会(JOA)评分均高于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:经皮椎间孔镜下髓核摘除术治疗复发性腰椎间盘突出症患者可提高腰椎功能JOA评分,降低术中出血量、ODI评分、VAS评分,缩短手术时间和术后住院时间,效果优于经椎间孔腰椎椎体间融合术治疗。

Objective:To compare effects of percutaneous transforaminal endoscopic discectomy and transforaminal lumbar interbody fusion in treatment of patients with recurrent lumbar disc herniation.Methods:A prospective study was conducted on 110 patients with recurrent lumbar disc herniation admitted to this hospital from April 2020 to April 2021.They were divided into observation group and control group according to the random number table method,55 cases in each.The control group was treated with transforaminal lumbar interbody fusion,while the observation group was treated with percutaneous transforaminal endoscopic discectomy.The surgery time,the intraoperative blood loss,the postoperative hospitalization time,the Oswestry disability index(ODI)score,the visual analogue scale(VAS)score,the lumbar function JOA score,and the incidence of complications were compared between the two groups.Results:The intraoperative blood loss in the observation group was lower than that in the control group,the operation time and the postoperative hospitalization time were shorter than those in the control group,and the differences were statistically significant(P<0.05).1 week after the surgery,the ODI and VAS scores of the two groups were lower than those before the surgery,those of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).1 week and 6 months after the surgery,the JOA scores of lumbar function in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).However,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:Percutaneous transforaminal endoscopic discectomy for the patients with recurrent lumbar disc herniation can improve the JOA score of lumbar function,reduce the intraoperative blood loss,the ODI score,the VAS score,and shorten the operation time and the postoperative hospitalization time.Moreover,it is superior to transforaminal lumbar interbody fusion.