经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症临床疗效比较  

Comparison of clinical efficacy of percutaneous transforaminal endoscopic discectomy with simple vertebral lamina fenestration in treatment of lumbar disc herniation

作　　者：韩康[1,2] 高浩然[1] 卞娜[1] 高全友 薛为高 刘永明[1] 周勇[1] 钱济先[1] 

机构地区：[1]第四军医大学唐都医院全军骨科中心暨全军骨肿瘤研究所,西安市710038 [2]山东省济南军区总医院脊髓修复科,250000

出　　处：《中华全科医学》2015年第6期868-871,1037,共4页Chinese Journal of General Practice

基　　金：国家自然科学基金(81272441)

摘　　要：目的将经皮椎间孔镜(PTED)与单纯椎板开窗术治疗腰椎间盘突出症的临床效果和安全性进行比较,以了解椎间孔镜的优势和不足。方法回顾性分析2012—2014第四军医大学唐都医院行PTED手术或传统椎板间开窗术的椎间盘患者共计216例。经皮椎间孔镜治疗(PTED组)为142人,传统椎板开窗髓核摘除术为74人(对照组)。通过术后随访,记录并评价2组患者在住院时间、手术时间、出血量、卧床时间、术前后的VAS疼痛评分、OSWESTRY功能障碍指数评定(ODI)、Lehmann腰椎功能评分、Mac Nab疗效的数据并进行统计学比较。结果2组患者在术后疼痛评分、OSWESTRY功能障碍指数、腰椎功能评分等方面较术前差异有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05)。PTED组患者在住院时间(5.9±1.6)d,手术时间(1.0±0.4)h,卧床时间(1.1±0.5)d、术中出血量(40.0±18.5)ml等方面PTED组显著高于对照组,差异有统计学意义(P<0.05)。而在总费用、并发症等方面则差异无统计学意义(P>0.05)。结论经皮椎间孔镜技术在治疗效果上与传统单纯椎板开窗术并无明显差异,但是在某些方面具有较为明显的优势,可在腰椎间盘突出症的临床工作中进一步的开展和推广。Objective To compare the clinical effect and safety of percutaneous transforaminal endoscopic discectomy （PTED） and vertebral lamina fenestration in the treatment of lumbar disc hemiation（LDH） ,and evaluate the advantages and disadvantages of PTED. Methods We retrospectively reviewed the clinical data of 216 patients with LDH in our hos- pital from 2012 to 2014. 142 patients underwent PTED （PTED group） and 74 underwent vertebral lamina fenestration （control group）. The clinical outcomes were evaluated by the length of stay, operation time, amount of bleeding, bed rest time, pre- and post-operative VAS scores, OSWESTRY disability index（ ODI）, Lehmann Low-Back Rating Scale and mod- ified Macnab criteria between two groups. Results The VAS score, ODI, and lumbar function of the patients was signifi- cantly better than pre-operation, but there was no difference between the two groups. The hospitalization time （5.9 ± 1.6） d, amount of blooding（40.0± 18.5 ） ml, bed rest time （ 1.1 ± 0.5 ） d and operation time （ 1.0 ± 0.4 ） h of PELD group were significantly better when compared with the control group（ P 〈 0.05 ）. There was no difference between two groups in cost and the complications. Conclusion PTED,with obvious advantages in some aspects in the treatment of lumbar disc herniation, can achieve a similar curative efficacy to vertebral lamina fenestration ,which could be further carried out in the clinical work.

关 键 词：腰椎间盘突出症 椎间孔镜 单纯椎板开窗术 

分 类 号：R581.53[医药卫生—内分泌]