经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究  

Comparative Study of Percutaneous Transforaminal Endoscopic Discectomy Versus Fenestration Discectomy in Patients with Lumbar Disc Herniation

作　　者：金丹杰[1] 徐南伟[1] 赵国辉[1] 陈孜[1] 周栋[1] 农鲁民 张云坤[1] 

机构地区：[1]常州市第二人民医院骨科,常州213000

出　　处：《中国微创外科杂志》2017年第6期491-494,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)与椎板开窗椎间盘切除术(fenestration discectomy,FD)治疗腰椎间盘突出症患者的效果。方法选择我院2014年3月~2016年2月90例单节段单侧腰椎间盘突出症,按随机数字表随机分为FD组和PTED组,每组45例。FD组采用椎板开窗髓核摘除术,即硬膜外麻醉,单侧椎板开窗减压、髓核摘除以及神经根减压松解。PTED组实施经皮椎间孔镜技术,即在局麻内镜下切除突出的椎间盘髓核组织,并进行神经根的减压和松解。比较2组手术时间、切口长度、术后住院时间、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)以及末次随访时疗效情况。结果 2组患者均顺利完成手术。PTED组手术时间(82.8±34.3)min,与FD组(75.4±35.6)min无统计学差异(t=1.004,P=0.318);2组切口长度[(0.5±0.2)cm vs.(3.1±0.3)cm,t=-48.374,P=0.000]、住院时间[(7.8±2.3)d vs.(10.1±3.3)d,t=-3.836,P=0.000]差异均有统计学意义。90例随访6~20个月,平均13个月,无一例腰椎间盘突出复发。与术前比较,术后2组VAS、ODI评分显著降低(P<0.05),但2组间比较差异无统计学意义(P>0.05)。PTED组优良率为93.3%(42/45),FD组优良率88.9%(40/45),2组比较差异无统计学意义(Z=-0.566,P=0.571)。结论 FD和PTED治疗腰椎间盘突出症疗效无差异,但PTED手术切口小、术后住院时间短、恢复快。Objective To compare the effects of percutaneous transforaminal endoscopic discectomy （PTED） versus fenestration discectomy （FD） in patients with lumbar disc herniation （ LDH）. Methods A total of 90 patients with single segmental unilateral LDH in our hospital from March 2014 to February 2016 were selected and randomly divided into either FD group （n = 45 ） or PTED group （n = 45 ）. The FD group was performed with FD （epidural anesthesia, unilateral vertebral lamina windowing decompression, removal of nucleus pulposus, and nerve root decompression and release） while the PTED group with PTED （local anesthesia, removal of herniated nucleus pulposus and nerve root decompression and release）. After operation all the patients were followed up. The duration of operation, length of incision, postoperative hospital stay, visual analogue scale （VAS）, Oswestry disability index （ODI） , and therapeutic effect at the time of final follow-up were compared between the two groups. Results The operation was finished successfully in all the patients of both groups. The duration of operation in the PTED group [ （ 82.8±34.3） mini was longer than that of the FD group [ （75.4 ± 35.6） min ], but the difference was not significant （ t = 1. 004, P = 0. 318 ）. There were statistical differences between the two groups regarding the length of incision [ （0.5 ±0.2） cm vs. （3.1 ±0.3 ） cm, t = 48. 374, P =0.000] and postoperative hospital stay [ （7.8 ±2.3） d vs. （10.1 ±3.3） d, t = -3. 836, P =0.000]. Ninety patients were followed up for 6 to 20 months （ mean, 13 months） ,and no recurrence of LDH was found. As compared with operation before, the VAS and ODI scores decreased significantly in both groups after operation with significant difference （ P 〈 0.05 ）, but the difference between the two groups was not significant （P 〉 0. 05）. The excellent and good rate was 93.3% （42/45） in the PTED group and 88.9% （40/45） in the FD group, and the difference was

关 键 词：经皮椎间孔镜椎间盘切除术 椎板开窗椎间盘切除术 腰椎间盘突出症 

分 类 号：R687.3[医药卫生—骨科学]