经皮椎间孔镜下腰椎间盘髓核摘除术和开放腰椎间髓核摘除术治疗青少年腰椎间盘突出症的临床观察

Clinical observation of percutaneous endoscopic lumbar discectomy and open lumbar discectomy in treating lumbar disc herniation

目的:探讨经皮椎间孔镜下腰椎间盘髓核摘除术(PELD)和开放腰椎间髓核摘除术治疗青少年腰椎间盘突出症(LDH)的临床疗效。方法:回顾性分析2018年1月至2020年1月间50例青少年LDH患者资料,严格遵照手术治疗指征分为两组,其中符合PELD手术指征的26例患者纳入PELD组,另外24例符合开放腰椎间髓核摘除术治疗指征则纳入开放组,比较两组患者手术情况(包括手术时间、术中出血量、下床活动时间、住院时间)、治疗有效率、治疗前后日本骨科学会(JOA)腰腿痛评分、视觉模拟评分(VAS)及并发症发生率。结果:PELD组术中出血量少于开放组,手术时间、下床活动时间、住院时间均明显短于开放组,组间差异显著(P<0.05);开放组患者术后有84.62%的患者功能及疼痛得到显著改善,PELD组则为87.50%,两组患者的临床治疗效果相比无统计学差异(P>0.05),两组患者的术后并发症发生率相比无统计学差异(P>0.05),治疗前两组JOA及VAS评分指数对比无统计学差异(P>0.05);术后3 d时PELD组的VAS评分明显低于开放组(P<0.05),在术后1个月与术后3个月时两组VAS评分均无统计学差异(P>0.05);而两组JOA评分在术后3 d~术后3个月时比较无统计学差异(P>0.05)。结论:PELD在治疗青少年LDH方面有独特的优越性,可缩短手术耗时,减少创伤范围,减轻术后疼痛,有利于患者早日康复,尽快恢复正常学业与生活。

Objective:To discuss the clinical effects of percutaneous endoscopic lumbar discectomy(PELD)and open lumbar discectomy in treating lumbar disc herniation(LDH).Methods:Clinical data of 50 adolescents with LDH(from Jan.2018 to Jan.2020)was retrospectively analyzed.According to guidelines of different therapies,26 cases received PELD(PELD group),and 24 cases received the open lumbar discectomym(open group).Peri‑operation records such as operation time,intraoperative bleeding volume,time to first ambulation,and hospital stays,as well as effective treatment rate,Jap‑anese Orthopaedic Association(JOA)scores,visual analogue scale(VAS)scores,and complication rate were compared.Results:In PELD group,intraoperative bleeding volume was smaller,and oper‑ation time,time to first ambulation and hospital stays were shorter than those in open group(P<0.05).No significant difference was found in postoperative function and pain improvement rate be‑tween PELD group(87.50%)and open group(84.62%)(P>0.05).And no significant difference was also found in postoperative complications and pre‑operation JOA and VAS scores(P>0.05).But the VAS scores in PELD group were lower than in open group with 3 d after operation(P<0.05),while the difference was not signicant after 1 month and 3 months of surgery(P>0.05).During the follow‑up period of 3 d to 3 months after surgery,there were no significant differences in JOA scores be‑tween the two groups(P>0.05).Conclusion:PELD has its advantages for the treatment of LDH,which can shorten the operation time,relieve the clinical trauma and pain,promote the fast‑recovery and return to normal quickly.