PELD与TLIF治疗腰椎间盘突出症并神经根管狭窄疗效比较  

Comparison of clinical effects between percutaneous endoscopic lumbar discectomy and transforaminal lumbar interbody fusion in the treatment of lumbar disc herniation and nerve root canal stenosis

作　　者：禤天航 曹正霖[1] 关宏刚[1] 王刚[1] 肖隆艺[1] 付忠泉[1] 

机构地区：[1]广东省佛山市中医院,广东佛山528000 [2]广州中医药大学,广东广州510405

出　　处：《现代中西医结合杂志》2015年第28期3085-3088,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的比较经皮椎间孔镜髓核摘除术(PELD)和经椎间孔入路腰椎体间融合术(TLIF)治疗腰椎间盘突出症并神经根管狭窄的临床疗效。方法根据治疗方法不同将38例腰椎间盘突出症并神经根管狭窄患者分为2组:17例行PELD术治疗者作为PELD组,21例行TLIF术治疗者作为TLIF组,2组均随访12个月。比较2组手术完成情况,术中及术后并发症发生情况,治疗前后VAS评分、ODI评分变化,随访12个月手术疗效。结果 PELD组手术切口小于TLIF组(P<0.05),手术时间、住院时间均短于TLIF组(P均<0.05)。2组并发症发生率比较差异无统计学意义。PELD组术后1 d VAS评分明显低于TLIF组(P<0.05),2组术后1,6,12个月VAS评分比较差异无统计学意义。2组术后12个月ODI评分及改良Macnab疗效评价优良率比较差异均无统计学意义。结论 PELD与TLIF均是治疗腰椎间盘突出症并神经根管狭窄的有效手段。尽管前者学习曲线更陡峭,但其相对于后者更具微创性,对邻近节段的影响更小。Objective It is to compare the clinical effects between the percutaneous endoscopic lumbar discectomy （PELD） and transforaminal lumbar interbody fusion（TLIF） in the treatment of lumbar disc herniation and nerve root canal stenosis .Methods 38 patients with lumbar disc herniation and nerve root canal stenosis were divided into two groups according to their treatment method：17 cases treated with PELD as PELD group, and other 21 patients received TLIF as TLIF group, both the two groups were followed up for 12 months.The operation finishing, occurrence of complications during and after sur-gery, the changes of visual analogue scale（VAS） and Oswestry disability index（ODI） before and after the operation were com-pared between the two groups.Results The cut area of PELD group was smaller while operation time and hospitalizaion time were shorter than that of TLIF group （P all〈0.05）.There was no significant difference in the occurrence rate of complication between the two groups.The VAS scores in one day after operation was lower in PELD group than that in TLIF group （P〈0. 05）, but the differences were not significant in 1, 6, 12 months between the two groups.There was no significant difference in ODI scores and good rate evaluated by modified Macnab criteria in 12 months after operation between the two groups.Conclu-sion Both PELD and TLIF are the effective methods of treatment for lumbar disc herniation and nerve root canal stenosis.Rela-tive to the TLIF ,although the former＇s learning curve is more steepen, it shows advantages in representing more minimally in-vasive, lowering health care costs and influencing less on adjacent segment.

关 键 词：腰椎间盘突出症 神经根管狭窄 经皮椎间孔镜 椎间融合术 微创手术 

分 类 号：R681.53[医药卫生—骨科学]