侧后路椎间孔镜手术与后路椎间盘镜手术对腰椎间盘突出症患者手术相关指标及腰椎功能的影响对比

Comparison of the Effects of Lateral-Posterior Approach Transforaminal Endoscopic Surgery and Posterior Discoscopic Surgery on Surgical Indicators and Lumbar Function in Patients with Lumbar Disc Herniation

目的探讨侧后路椎间孔镜手术与后路椎间盘镜手术对腰椎间盘突出症(LDH)患者的影响。方法选取2020年7月—2023年7月山东省第一康复医院收治的150例LDH患者为研究对象,按随机数字表法将其分为对照组和观察组,各75例。对照组行后路椎间盘镜手术,观察组行侧后路椎间孔镜手术。对比两组的手术相关指标、疼痛程度与腰椎功能、生活质量及并发症的发生情况。结果观察组术中出血量为(20.53±4.29)mL,少于对照组的(51.89±6.75)mL,手术时间为(82.39±9.36)min,长于对照组的(45.56±7.21)min,而下床活动时间为(1.61±0.42)d,短于对照组的(2.57±0.63)d,住院时间为(4.36±1.35)d,短于对照组的(7.15±1.89)d,组间差异有统计学意义(P<0.05)。术后1个月,观察组疼痛视觉模拟评分法评分为(1.24±0.37)分,Oswestry功能障碍指数为(10.26±1.75)分,均低于对照组的(2.57±0.58)分、(14.30±2.24)分,组间差异有统计学意义(P<0.05)。术后1个月,观察组生活质量综合评定问卷各维度评分分别为(76.97±5.13)分、(78.95±4.26)分、(79.25±4.41)分、(81.25±4.25)分,均高于对照组的(68.83±4.25)分、(70.29±3.58)分、(67.96±3.83)分、(72.84±3.96)分,组间差异有统计学意义(P<0.05);两组并发症发生率比较,差异无统计学意义(P>0.05)。结论侧后路椎间孔镜手术虽然会延长手术时间,但创伤更小,下床时间短,住院时间短,腰椎功能快速康复,可提高生活质量,且无严重并发症。

Objective To investigate the effects of lateral-posterior approach transforaminal endoscopic surgery and posterior discoscopic surgery on patients with lumbar disc herniation(LDH).Methods A total of 150 LDH patients admitted to the First Rehabilitation Hospital of Shandong Province from July 2020 to July 2023 were selected as the research objects,and were divided into a control group and an observation group according to random number table method,with 75 cases in each group.The control group underwent posterior discoscopic surgery,and the observation group underwent lateral-posterior approach transforaminal endoscopic surgery.The relative indexes,pain degree,lumbar spine function,quality of life and complications were compared between the two groups.Results The intraoperative blood loss in the observation group was(20.53±4.29)mL,less than(51.89±6.75)mL in the control group,the operative time was(82.39±9.36)min,longer than(45.56±7.21)min in the control group,and the time of getting out of bed was(1.61±0.42)d,it was shorter than(2.57±0.63)d the control group,and the length of hospitalization was(4.36±1.35)d,which was shorter than(7.15±1.89)d the control group,and the difference was statistically significant(P<0.05).One month after surgery,the pain Visual Analogue Scale score and Oswestry Disability Index of the observation group were(1.24±0.37)points and(10.26±1.75)points,both lower than(2.57±0.58)points and(14.30±2.24)points of the control group,and the differences between groups were statistically significant(P<0.05).One month after surgery,the scores of all dimensions in the Generic Quality of Life Inventory-74 were(76.97±5.13)points,(78.95±4.26)points,(79.25±4.41)points,(81.25±4.25)points,respectively.They were higher than(68.83±4.25)points,(70.29±3.58)points,(67.96±3.83)points and(72.84±3.96)points in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in complications between the two groups(P>0.05).Conclusion Although lateral-posterior approach transforaminal endoscopic surgery can prolong the surgical time,it has smaller trauma,shorter time to get out of bed,shorter hospital stay,faster recovery of lumbar spine function,can improved quality of life,and no serious complications.