经皮椎间孔镜与椎板开窗治疗腰椎间盘突出症的前瞻性随机对照研究

A Prospective and Controlled Study of Two Surgical Treatment of Lumbar Disc Herniation:Percutaneous Transfouraminal Endoscope Discectomy(PTED) and Fenestration Discectomy(FD)

目的比较经皮椎间孔镜技术和椎板开窗椎间盘切除术治疗单节段腰椎间盘突出症近期疗效及优缺点。方法选择2015年10月-2017年1月在我院收治的腰椎间盘突出症患者60例,采用前瞻性随机对照研究将其分为试验组和对照组,每组30例,试验组应用经皮椎间孔镜技术切除椎间盘对神经根进行松解、减压,对照组采用单侧椎板开窗减压术。分别于术前、术后3天、3个月、6个月随访时采用疼痛视觉模拟评分法visual analog scale(VAS)和JOA评分对患者的临床疗效进行评估,于术后6个月时采用Mac Nab量表评价手术疗效。记录切口长度、手术时间、术后卧床时间、平均住院日。结果 60例均顺利完成手术,试验组1例患者因血肿形成行术区穿刺排出随访,59例患者获得随访,随访时间均为6个月。两组患者术后3天、3个月、6个月腿痛VAS、JOA评分比较差异无统计学意义(P>0.05);术后3天腰痛VAS评分比较差异具有统计学意义(P<0.05),术后3个月、6个月腰痛VAS评分比较差异无统计学意义(P>0.05);术后6个月时改良Mac Nab评价疗效两组差异无统计学意义(P>0.05);两组切口长度、术后卧床时间、平均住院日差异具有统计学意义(P<0.05),试验组优于对照组;两组手术时间差异具有统计学意义(P<0.05),对照组优于实验组。试验组1例术后出现硬膜外血肿。结论经皮椎间孔镜和椎板开窗治疗腰椎间盘突出症都可取得满意疗效,经皮椎间孔镜具有创伤小,术后恢复快等优点,但也存在操作空间小、学习曲线陡、手术时间长等不足。

Objective To compare the recent clinical effect and advantages and disadvantages of percutaneous transfouraminal endoscope discectomy and fenestration discectomy in the treatment of single segmental lumbar disc herniation. Methods From October 2015 to January 2017,60 cases with lumbar disc herniation were randomly divided into experimental group and control group, 30 cases in each group, the experimental group the nerve roots were decompressed with PTED, control group adopted unilateral FD decompression. VAS score、JOA score,and modified Mac Nab evaluation criteria were used to assess clinical outcomes before surgery, on the 3 days and 3 months, 6 months after surgery. Record the data of two groups,including incision length,operation time, postoperative bed time,average length of stay,et al. Result 60 cases were successfully completed surgery, in the experimental group 1 patients who undergone lumbar puncture to treat hematoma was discharged follow-up,59 cases received follow-up,follow-up time was 6 months.The leg pain VAS, JOA score comparison differences has no statistical significance in two groups after 3 days, 3 months, 6 months(P > 0.05);After 3 days the back pain VAS score had differences(P<0.05),there no differences after 3 months, 6 months(P> 0.05); Modified Mac Nab curative effect evaluation of differences between the two groups have no statistical significance after 6 months(P> 0.05);The two groups differences of including incision length, postoperative bed time,average length of stay were statistically significant(P< 0.05), the experimental group was better than the control group;The operation time differences were statistically significant(P< 0.05), the control group was better than the experimental group. Conclusion PTED and FD have satisfactory curative effect in treatment of lumbar disc herniation, PTED has small incision, recovery quickly, etc advantages, but there are operating space is smaller, steep learning curve, more longer operation time, etc disadvantages.