经皮椎间孔镜与椎板开窗治疗腰椎间盘突出症的疗效分析  

The Efficacy of Two Surgical Treatment of Lumbar Disc Herniation:Percutaneous Transforaminal Endoscopic Discectomy and Fenestration Discectomy

作　　者：方卫军[1] 李章华 潘峰[1] 许海甲 侯煜东 

机构地区：[1]武汉大学人民医院,湖北武汉430060 [2]武汉市第三医院,湖北武汉430060

出　　处：《现代生物医学进展》2016年第34期6660-6664,6709,共6页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81472103)

摘　　要：目的:探讨经皮侧路椎间孔镜下椎间盘髓核摘除术(percutaneous transforaminal endoscopic discectomy,PTED)与后路椎板开窗髓核摘除术(fenestration decompression,FD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:回顾性分析2014年1月至2015年6月,在我院治疗确诊为单节段腰椎间盘突出症的患者80例,其中经皮椎间孔镜治疗(PTED组)37例,椎间开窗髓核摘除术(FD组)43例,记录两组患者术中透视次数、切口长度、手术时间、术中出血量、术后卧床及住院时间,治疗前后视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI)进行随访,评估两种手术方式治疗效果。结果:PTED组在手术切口长度(7.91±0.69 mm VS 64.09±9.90 mm)、术中出血量(9.77±2.36 mL VS 64.16±16.95 mL)、术后卧床时间(6.31±2.31 h VS 81.55±77.93 h)及住院时间(3.79±1.14 d VS 8.65±2.27-d)的比较上优于FD组,差异性均有统计学意义;FD组较PTED组在手术时间更短(58.23±9.98 min VS 88.00±10.82 min)、术中透视次数更少(2.74±0.90次VS 16.54±3.10次),差异性均有统计学意义。两组VAS、ODI评分术后与术前比较,均有明显地改善,差异性有统计学意义(t=1.06,P=0.00)。末次随访Macnab标准疗效评分,PTED组优良率为83.78-%,FD组优良率为79.06-%,两组比较差异无统计学意义(x^2=0.874P=0.918)。结论:PTED和FD两种手术方式均能有效治疗单节段腰椎间盘突出症;PTED手术方式具有手术切口小、术中出血量少、术后卧床及住院时间短、术后并发症少及恢复快等优点。FD具有X射线辐射小,手术时间更短,学习曲线短、更易掌握等优点。Objective： To discuss the clinical efficacy of two surgical treatment on lumbar disc herniation： percntaneous transforaminal endoscopic discectomy （PTED） and fenestration discectomy （FD）. Methods： Retrospectively analyzed 80 cases with single segmental lumbar disc disease between January 2014 and June 2015, 37 cases in PTED group, the other 43 cases in FD. Recorded the data of two groups, including the number of fluoroscopy times, length of the incision, operation time, amount of bleeding, ambulation time and hospitalization time. The surgery efficacy of two groups can be judged with VAS and ODI score between pre and post surgery. Results： The PTED group was superior to FD group on the length of the incision （7.91± 0.69 mm VS 64.09± 9.90 mm）, the amount of bleeding （9.77 ± 2.36 mL VS 64.16± 16.95 mL）, the ambulation time （6.31 ± 2.31 h VS 81.55 ± 77.93 h） and the hospitalization time （3.79± 1.14 d VS 8.65± 2.27 d ）, the difference between two group had statistically significant. The FD group had more fewer the fluoroscopic times （2.74± 0.90 VS 16.54± 3.10 ） and shorter the operation time （58.23± 9.98 min VS 88.00± 10.82 min） than PTED group, the difference between two group had statistically significant. All patients were followed up. The score of Macnab was no difference between the two groups, and had no statistically significant difference. The postoperative ODI and VAS scores in both groups were significantly improved when compared with those before the operation （t=-1.06, P=0.00）. According to the last follow-up modified Macnab criteria, PTED and FD group in the excellent and good rate are respectively 83.78-% and 79.06 %, there were no statistically significantly difference （XZ=0.874, P=0.918）. Conclusions： Both PTED and FD were effective to treat LDH. The PTED significantly had the advantage of small incision but accurate operation and reduced the amount of bleeding, ambulation time, hospitalization time, postoperative complications as well as q

关 键 词：椎间孔镜下椎间盘髓核摘除术 椎板开窗髓核摘除术 腰椎间盘突出症 疗效 

分 类 号：R681.53[医药卫生—骨科学]