摘要
目的:以经皮内镜经椎间孔入路腰椎间盘切除术(PETD)作为对照,探讨经皮内镜经椎板间入路腰椎间盘切除术(PEID)治疗下腰椎椎间盘突出症(LDH)患者的临床应用价值。方法:回顾性分析2018年1月至2021年5月收治的136例下腰椎LDH患者,包括L4/5 LDH患者75例,其中39例采用PETD,36例采用PEID;L5/S1 LDH患者61例,其中36例采用PETD,25例采用PEID。记录并比较患者术中透视次数、手术时间、术后住院时间,及术前和术后1 d、1个月及6个月疼痛视觉模拟量表评分(VAS)、Oswestry功能障碍指数(ODI),以及并发症发生情况。结果:所有患者均顺利完成手术。无论L4/5还是L5/S1 LDH患者,PEID组患者术中透视次数少于PETD组患者,且差异有统计学意义(P<0.001),而两组患者手术时间、术后住院时间差异均无统计学意义(P均>0.05)。无论L4/5还是L5/S1 LDH患者,无论采用PEID还是PETD,患者术后1 d、1个月及6个月VAS评分、ODI均低于术前,且差异均有统计学意义(P均<0.05)。无论L4/5还是L5/S1 LDH患者,术前、术后1 d、1个月及6个月PEID组与PETD组患者VAS评分、ODI差异均无统计学意义(P均>0.05)。PETD组1例患者术后出现椎间隙感染。无一例患者复发。结论:与PETD比较,PEID治疗下腰椎(L4/5,L5/S1) LDH患者同样有效,且术中辐射明显更少。应依据具体情况选择合适的手术入路。
Objective: To compare the clinical outcome between percutaneous endoscopic transforaminal discectomy(PETD and percutaneous endoscopic interlaminar discectomy(PEID) for lower lumbar disc herniation(LDH). Methods: A total of 136 patients with lower LDH who were treated by PETD or PEID from January 2018 to May 2021 were analyzed retrospectively. L4/5 was involved in 75 patients including 39 PETD and 36 PEID, and L5/S1 was involved in 61 patients including 36 PETD and25 PEID. Intraoperative perspective frequency, operation time, postoperative hospital stay, complications, visual analogue scale(VAS) score and Oswestry disability index(ODI) before operation and at 1 d, 1 month and 6 months postoperatively were recorded. Results: The operation was successfully completed in all the patients. Intraoperative perspective frequency in PEID group was significantly lower than that in PETD group(P<0.001). There were no significant differences in operation time or postoperative hospital stay between the PEID group and PETD group(P>0.05). VAS score and ODI of all the patients were significantly improved at 1 d, 1 month and 6 months postoperatively(P<0.05). There were no significant differences in the VAS score or ODI at any time point between the PEID group and PETD group(P>0.05). There was 1 case of postoperative intervertebral space infection in the PETD group. No recurrence occurred. Conclusions: Compared with PETD, PEID is also an effective treatment for lower LDH(L4/5, L5/S1), but intraoperative radiation can be significantly reduced. The appropriate surgical approach should be individually selected.
作者
金祺
陆彬彬
高爱国
周颖川
顾晓峰
JIN Qi;LU Binbin;GAO Aiguo;ZHOU Yingchuan;GU Xiaofeng(Department of Orthopaedics,Wuxi People's Hospital,Nanjing Medical University,Wuxi 214000,Jiangsu,China)
出处
《中华骨与关节外科杂志》
2021年第11期947-953,共7页
Chinese Journal of Bone and Joint Surgery
基金
无锡市科技局项目基金(CSE31N1703)。
