经皮脊柱内镜经椎间孔入路与椎板间入路治疗L5S1椎间盘突出症的疗效比较

Comparison of clinical efficacy of percutaneous spinal endoscopic transforaminal approach and interlaminar approach in treatment of L5S1 disc herniation

目的 比较经皮脊柱内镜经椎间孔入路与椎板间入路治疗L5S1椎间盘突出症的临床疗效。方法 回顾性分析自2016-05—2017-08采用经皮脊柱内镜治疗的70例L5S1椎间盘突出症,根据手术入路不同分为椎间孔入路组(35例)和椎板间入路组(35例)。比较两组术中X线透视次数,术后1周、术后3个月、术后6个月、末次随访时疼痛VAS评分、ODI指数,以及末次随访时疗效评定结果(采用MacNab标准评价)。结果 70例均获得随访,椎间孔入路组随访时间为36~48(44.06±4.54)个月,椎板间入路组随访时间为36~48(43.26±4.31)个月。椎板间入路组术中X线透视次数少于椎间孔入路组,差异有统计学意义(P<0.05)。椎间孔入路组与椎板间入路组术后疼痛VAS评分、ODI指数均较术前明显改善,差异有统计学意义(P<0.05)。两组术后1周、术后3个月、术后6个月、末次随访时疼痛VAS评分、ODI指数比较差异无统计学意义(P>0.05)。两组末次随访时疗效评定结果差异无统计学意义(P>0.05)。结论 经皮脊柱内镜微创手术治疗L5S1椎间盘突出症可取得满意疗效,考虑到L5S1椎间隙特殊的解剖结构,临床医师应严格掌握经椎间孔入路和经椎板间入路手术不同的适应证,进而有效改善患者临床症状。

Objective To compare the clinical effects of percutaneous spinal endoscopic transforaminal approach and interlam-inar approach in the treatment of L,S,intervertebral disc herniation.Methods Seventy cases of L,S,disc herniation treated by percutaneous spinal endoscopy from May 2016 to August 2017 were analyzed retrospectively.According to the different surgi-cal approaches,they were divided into transforaminal approach group(35 cases)and interlaminar approach group(35 cases).The number of intraoperative X-ray fluoroscopy,Visual analogue scale(VAS)score,Oswestry disability index(ODI)and Macnab standard at the last follow-up were compared between the two groups at 1 week,3 months,6 months after operation.Results All 70 cases were followed up.The follow-up time was 36-48(44.06±4.54)months in the transforaminal group and 36-48(43.26±4.31)months in the interlaminar group.The number of X-ray fluoroscopy in the interlaminar approach group was less than that in the transforaminal approach group,and the difference was statistically significant(P<0.05).The postopera-tive VAS score and ODI index in the transforaminal approach group and the interlaminar approach group were significantly im-proved compared with those before operation,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in VAS score and ODI index at 1 week,3 months,6 months and the last fol-low-up(P>0.05).There was no statistically significant difference in results of curative effect between the two groups at the last follow-up(P>0.05).Conclusion Percutaneous spinal endoscopic minimally invasive surgery for L,S,disc herniation can achieve satisfactory results.Considering the special anatomical structure of L5S1 intervertebral space,clinicians should strictly grasp the different indications of transforaminal approach and interlaminar approach operations,and then improve the clinical symptoms of patients effectively.