PEID与PETD治疗L_(5)-S_(1)椎间盘突出症患者的效果比较

Comparison of effects of PEID and PETD in treatment of patients with L_(5)-S_(1) lumbar disc herniation

目的:比较椎板间入路脊柱内镜髓核摘除术(PEID)与椎间孔入路脊柱内镜髓核摘除术(PETD)治疗L_(5)-S_(1)椎间盘突出症(LDH)患者的效果。方法:选取2020年4月至2022年4月该院收治的92例L_(5)-S_(1)LDH患者进行前瞻性研究,按照随机数字表法分为对照组和观察组各46例。对照组接受PETD治疗,观察组接受PEID治疗。比较两组手术优良率、手术相关指标(术中透视次数,手术时间)水平、手术前后疼痛数字量表(NRS)评分、Oswestry功能障碍指数(ODI)评分、创伤应激因子指标[降钙素原(PCT)、磷脂酶A2(PLA2)、C反应蛋白(CRP)、M型脑钠肽(M-ENK)]水平和并发症发生率。结果:两组手术优良率比较,差异无统计学意义(P>0.05);术后,两组ODI、NRS评分均低于术前,但组间比较,差异无统计学意义(P>0.05);观察组术中透视次数少于对照组,手术时间短于对照组,差异均有统计学意义(P<0.05);术后1、3 d,两组血清PCT、PLA2、CRP水平均高于术前,但观察组低于对照组,两组血清M-ENK水平均低于术前,但观察组高于对照组,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:PEID与PETD治疗L_(5)-S_(1)LDH患者的手术效果相当,但PEID可降低手术相关指标水平,改善创伤应激因子指标水平,优于PETD治疗效果。

Objective:To compare effects of percutaneous endoscopic interlaminar discectomy(PEID)and percutaneous endoscopic transforaminal discectomy(PETD)in treatment of patients with L_(5)-S_(1) lumbar disc herniation(LDH).Methods:A prospective study was conducted on 92 patients with L_(5)-S_(1) LDH admitted to our hospital from April 2020 to April 2022.They were divided into control group and observation group according to the random number table method,46 cases in each group.The control group was treated with PETD,while the observation group was treated with PEID.The excellent and good rate of the surgery,the surgery related indexes(number of intraoperative fluoroscopy,operation time),the numerical rating scale(NRS)scores before and after the surgery,the Oswestry dysfunction index(ODI)score,the traumatic stress factor levels[procalcitonin(PCT),phospholipase A2(PLA2),C-reactive protein(CRP),M-type brain natriuretic peptide(M-ENK)],and the incidence of complications were compared between the two groups.Results:There was no significant difference in the excellent and good rate between the two groups(P>0.05).After the surgery,the ODI and NRS 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).The number of intraoperative fluoroscopy in the observation group was less than that in the control group,the operation time was shorter than that in the control group,and the differences were statistically significant(P<0.05).1 and 3 days after the surgery,the levels of serum PCT,PLA2 and CRP in the two groups were higher than those before the treatment,but those in the observation group were lower than those in the control group;the serum M-ENK levels of the two groups were lower than those before the treatment,but those in the observation group were higher than those in the control group;and the difference was statistically significant(P<0.05).Further,there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions:PEID and PETD have similar surgical effects in the treatment of the L_(5)-S_(1) LDH patients,but PEID can reduce the levels of surgical related indicators and improve the levels of traumatic stress factors.It is better than PETD treatment.