经皮椎间孔镜椎间盘切除术与椎板开窗髓核摘除术对脊柱运动单位影响的对比研究  

Contrastive study between percutaneous transforaminal endoscopic discectomy and fenestration laminectomy in affection of functional spinal unit

作　　者：张红鹤[1] 赵柳絮[1] 邓丽[1] 于海琦[1] 纪慧茹[1] 

机构地区：[1]中国人民武装警察部队总医院骨科中心,北京100039

出　　处：《脊柱外科杂志》2015年第4期223-227,共5页Journal of Spinal Surgery

摘　　要：目的评价经皮椎间孔镜椎间盘切除术（percutaneous transforaminal endoscopic discectomy,PTED）与椎板开窗髓核摘除术（fenestration laminectomy,FL）对腰椎手术节段的影响。方法 2008年3月~2012年3月本院收治单节段腰椎椎间盘突出症行PTED或FL患者82例,并获得完整随访,测量手术前后椎间隙高度、椎间孔高度、腰椎活动度变化情况及关节突关节间隙差、小关节角度差的变化情况,评估2种术式对脊柱运动单位的影响。结果 PTED组和FL组的平均随访时间分别为25.9个月和24.5个月。2组的手术节段椎间隙高度及椎间孔高度均降低,PTED组的丢失量均小于FL组,差异有统计学意义（P〈0.01）;2组的手术节段活动度均增加,FL组活动度增加大于PTED组,差异有统计学意义（P〈0.01）;PTED组关节突关节间隙差和小关节角度差较术前增加,差异有统计学意义（P〈0.05）,FL组则较术前降低,差异有统计学意义（P〈0.05）,2组相比差异有统计学意义（P〈0.01）。结论治疗单节段腰椎椎间盘突出症,PTED对椎间隙高度、椎间孔高度、手术节段运动功能的影响程度较FL小;FL对关节突关节间隙和小关节角度的影响程度较PTED小。Objective To discriminate different effect of functional spinal unit between percutaneous transforaminal endoscopic discectomy（ PTED） and fenestration laminectomy（ FL） on operation segment. Methods From March 2008 to March 2012,82 cases with single segmental lumbar disc herniation underwent PTED or FL,and obtained complete follow-up.Intervertebral space height（ ISH）,foraminal height（ FH）,range of motion（ ROM）,difference of interfacet distance（ DID）,and difference of facet joint angle（ DFJA） were analysed to investigate the variation of functional spinal unit. Results The mean time of follow-up for PTED team and FL team were 25. 9 months and 24. 5 months. ISH and FH of post-operation in both groups were lower than that of pre-operation. Variation of ISH and FH in FL team were more serious than PTED team（ P〈0. 05）. ROM of post-operation in both groups were increased than that of pre-operation. Variation of ROM in FL group was more serious than that in PTED group（ P〈0. 01）. DID and DFJA of post-operation in FL team were decreased than that of pre-operation（ P〈0. 05）. But DID and DFJA of post-operation in PTED group were increased than pre-operation（ P〈0. 05）.The statistical difference between 2 groups was significant（ P〈0. 01）. Conclusion In lumbar disc herniation theraphy,variation of ISH,FH and ROM in PTED group were preponderant than that in FL group,and difference of DID and DFJA in FL team were preponderant than that in PTED group.

关 键 词：腰椎 椎间盘移位 内窥镜检查 椎间盘切除术 经皮 

分 类 号：R681.533.1[医药卫生—骨科学]