椎间孔镜与椎间盘镜单切口治疗相邻双节段腰椎间盘突出症疗效对比  

Efficacy comparison between percutaneous transforaminal endoscopic discectomy and micro-endoscopic discectomy with single incision for adjacent double-segment lumbar disc protrusion

作　　者：李延坤 翟凯 田云虎[2] LI Yankun;ZHAI Kai;TIAN Yunhu(Department of Surgery,Weifang Medical University,Weifang 261053,China;Department of Spinal Surgery,the Affiliated Hospital of Weifang Medical University)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]潍坊医学院附属医院脊柱外科

出　　处：《潍坊医学院学报》2019年第5期354-357,共4页Acta Academiae Medicinae Weifang

摘　　要：目的比较经皮椎间孔镜(PTED)与椎间盘镜(MED)单切口治疗相邻双节段腰椎间盘突出症的临床疗效。方法回顾性分析自2016年4月~2019年1月我院诊治的相邻双节段腰椎间盘突出患者44例,根据随机数表法分为PTED组和MED组,每组各22例,比较2组的切口长度、术中出血量、手术时间、透视次数、住院时间及视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),对比2组手术前后Cobb角变化情况,并在末次随访时根据改良MacNab标准评估患者临床疗效。结果①PTED组在切口长度、术中出血量及住院时间上均优于MED组,但手术时间长于MED组,透视次数多于MED组,差异有统计学意义(P<0.05)。②与术前相比,两组在术后1个月、3个月及末次随访时的VAS评分和0DI指数上均明显降低,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。③MED组术后9个月Cobb角明显减小,与PTED组相比差异有统计学意义(P<0.05)。④末次随访时两组患者的MacNab疗效优良率分别为90.9%和86.4%,组间比较差异无统计学意义(χ~2=0.23,P>0.05)。结论 PTED与MED单切口治疗相邻双节段LDH疗效满意,具有可行性及安全性,其中PTED创伤更小,切口更短,术后恢复较快,对腰椎稳定性影响小,更具微创理念。但是PTED一孔处理双节段LDH操作难度大,学习曲线陡峭,对术者专业技能要求高,需严格把握手术适应证。Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy(PTED) and microendoscopic discectomy(MED) for adjacent bimodal lumbar disc herniation.Method Forty-four cases diagnosed with adjacent bilateral lumbar disc herniation were enrolled and analyzed retrospectively,ranged from April 2016 to January 2019.Random number table method was used to divide them into PTED group(n=22) and MED group(n=22).The incision length,intraoperative blood loss,operation time,fluoroscopy times,hospitalization time and visual simulation score(VAS),combined with Oswestry dysfunction index(ODI) were compared between the 2 groups.The changes of Cobb angle before and after operation were compared,and the clinical efficacy was assessed at the last follow-up,according to the modified MacNab criteria.Results ①The length of incision,the amount of intraoperative blood loss and hospitalization time in PTED group were less than that in MED group,but the operation time was longer,and the frequency of fluoroscopy was significantly more than MED group(P<0.05).②Compared with preoperative,the VAS score and 0 DI index of the 2 groups were significantly lower at 1 st and 3 rd month and,the last follow-up(P<0.05),but no significant difference was found between the 2 groups(P>0.05).③The Cobb angle in MED group decreased remarkably 9 months after the operation,which was significantly different from PTED group(P<0.05).④The MacNab curative rates of the 2 groups were 90.9% and 86.4% respectively,as evaluated in the last follow-up,and no significant difference was found between the 2 groups(χ~2=0.23,P>0.05).Conclusion PTED and MED single incision are effective,feasible and safe ways to treat adjacent two-segment LDH.Compared with MED,PTED causes less damage and recovers faster,what’s more,it keeps the lumber more stable after the surgery and the microinvasive conception is easily accepted by patients.However,it is difficult to operate two-segment LDH with one hole and higher-level of professional skills are re

关 键 词：椎间孔镜 椎间盘镜 相邻双节段 腰椎间盘突出症 

分 类 号：R681.53[医药卫生—骨科学]