经皮椎间孔镜下髓核切除术与显微椎间盘镜下髓核切除术治疗腰椎盘突出症的临床价值比较  

The comparison of clinical value between PTED and MED in the treatment of lumbar disc herniation

作　　者：宇洪浩 原泉[1] 王欢[1] 安春厚[1] 林新鸿 YU Hong-hao;YUAN Quan;WANG Huan;AN Chun-hou;LIN Xin-hong(Section of Spinal Surgery at The Second Department of Orthopedics,Shengjing Hospital,China Medical University,Shenyang 110004,China;China Medical University,Shenyang 110122,China)

机构地区：[1]中国医科大学附属盛京医院第二骨科脊柱外科疗区,辽宁沈阳110004 [2]中国医科大学,辽宁沈阳110122

出　　处：《实用医院临床杂志》2018年第5期57-60,共4页Practical Journal of Clinical Medicine

摘　　要：目的比较经皮椎间孔镜下髓核切除术(PTED)与显微椎间盘镜下髓核切除术(MED)治疗腰椎间盘突出症的临床价值。方法收集98例腰椎间盘突出症患者的临床资料,按治疗方式分为PTED组(n=45)与MED组(n=53),比较两组手术、术后恢复情况及视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会量表(JOA)评分结果,对比两组手术前后腰椎曲度Cobb角及椎间隙高度的变化。结果 (1)PTED组切口长度、术后卧床时间、住院时间短于MED组,但MED组手术时间短于PTED组,透视次数少于PTED组(P<0.05)。(2)两组术后并发症发生率比较差异无统计学意义(P>0.05)。(3)术后3、6个月,两组腰痛腿痛VAS评分及ODI障碍指数均降低、JOA评分上升(P<0.05),但组间比较差异无统计学意义(P>0.05)。(4)MED组术后6个月Cobb角缩小,与PTED组比较差异有统计学意义(P<0.05)。结论 PTED与MED治疗腰椎间盘突出症疗效肯定,可减轻患者疼痛,促进腰椎功能恢复,但前者创伤更小,术后恢复速度快,对腰椎稳定性影响更小。Objective To compare the clinical value of percutaneous transforaminal endoscopic discectomy （PTED） and micioendoscopic discectomy （MED） in the treatment of lumbar disc herniation.Methods Clinical data of 98 patients with lumbar disc herniation were collected.The patients were divided into PTED group （n=45 ） and MED group （n=53 ） according to different treat-ment methods.The situation of surgery, postoperative recovery, scores of visual analogue scale （VAS） ,Oswestry disability index （ODI） and results of Japanese Orthopaedic Association （JOA） score were compared between the two groups.Changes in Cobb angle of lumbar curvature and intervertebral height before and after surgery were also compared between the two groups.Results （X）The length of inci-sion ,postoperative time in bed and hospitalization time of the PTED group were shorter than those of the MED group （ P〈0.05 ） , but the surgical time and the fluoroscopy times of the MED group was shorter and less than those of the PTED group （ P〈0.05 ） . ？There was no significant difference in the incidence of postoperative complications between the two groups （P〉0.05 ）.？VAS scores of back and leg pain and ODI were decreased in the two groups after 3 and 6 months of surgery, while JOA scores were increased （ P〈0.05 ） .How-ever, there was no significant difference between the two groups （P〉0.05）. ①The Cobb angle of the MED group was decreased at 6 months after surgery which was significantly different from the PTED group （ P〈0.05 ）.Conclusion Both PTED and MED are effec-tive in the treatment of lumbar disc herniation to reduce patients5 pain and promote the recovery of lumbar function.However, the trauma of the former is smaller,so that patients can recover faster after surgery,and the effect on the stability of lumbar spine is less.

关 键 词：腰椎间盘突出症 神经根损伤 椎间孔镜 显微椎间盘镜 

分 类 号：R681.5[医药卫生—骨科学]