经皮内镜椎板间入路髓核摘除术与传统椎板开窗术治疗L5S1单节段椎间盘突出症的疗效比较  

Comparison of Clinical Efficacy of Percutaneous Endoscopic Interlaminar Discectomy and Traditional Interlaminar Fenestration Discectomy for the Treatment of L5S1 Single-Segment Lumbar Disc Herniation

作　　者：张辉 柳申鹏[1] 宋凯 丁远飞 万广[1] 梁秋冬[1] ZHANG Hui;LIU Shenpeng;SONG Kai(The First Affiliated Hospital of Xinxiang Medical University, Henan Xinxiang 453100, China)

机构地区：[1]新乡医学院第一附属医院骨外科,河南新乡453100

出　　处：《河北医学》2021年第4期609-614,共6页Hebei Medicine

基　　金：吴阶平医学基金会临床科研专项,(编号:320-2745-16-224)。

摘　　要：目的:探讨经皮内镜椎板间入路髓核摘除术(PEID)与传统椎板开窗术(FD)治疗L5S1单节段椎间盘突出症的疗效。方法:回顾性分析2018年1月至2019年5月行PEID或FD治疗的L5S1单节段椎间盘突出症患者66例,依据手术方案不同分组,PEID组(35例),采用局部麻醉,FD组(31例),采用全身麻醉。比较两组切口长度、手术时间、出血量、卧床时间、住院时间及并发症情况。评估两组术前、术后及末次随访腰腿痛视觉模拟VAS评分和ODI评分。末次随访采用改良Macnab标准评估疗效。对比两组患者术前、术后血清肌酸激酶(CK)活性及C反应蛋白(CRP)浓度变化。结果:根据改良Macnab标准,两组优良率分别为88.57%和87.09%,差异无统计学意义(χ^(2)=0.034,P=0.855);年龄分布和性别比例两组比较差异无统计学意义(P>0.05);PEID组出血量少于FD组,PEID组切口长度、手术时间、卧床时间、住院时间均短于FD组,差异均有统计学意义(P<0.05);PEID组术后各时间点腰痛VAS评分均低于FD组,差异均有统计学意义(P<0.05);两组腰腿痛VAS评分、ODI评分术后各时间点均低于术前,差异均有统计学意义(P<0.05);术后PEID组血清CK活性及CRP浓度低于FD组,差异有统计学意义(P<0.05)。并发症总发生率比较,差异无统计学意义(χ^(2)=0.053,P=0.818);结论:两种术式均可有效治疗L5S1椎间盘突出,PEID创伤更小,出血量更少,卧床时间更短,恢复更快,值得推广应用。Objective:To compare the clinical efficacy of percutaneous endoscopic interlaminar discectomy(PEID)and traditional interlaminar fenestration discectomy(FD)in the treatment of L5S1 single-segment lumbar disc herniation(LDH)patients.Methods:A retrospective analysis of 66 patients with L5S1 single-segment lumbar disc herniation who underwent percutaneous endoscopic interlaminar discectomy or traditional interlaminar fenestration discectomy from January 2018 to May 2019 were enrolled and divided into PEID group(35 cases)and FD group(31 cases)based on different surgical methods.Local anesthesia was applied to PEID group and general anesthesia to FD group.The incision length,operative time,intraoperative blood loss,postoperative bed time,duration of hospitalization and complications between two groups were compared.The Visual Analogue Score(VAS)and the Oswestry disability index(ODI)of two groups were evaluated preoperatively,postoperatively and in last follow-up.The Modified Macnab criteria was used to evaluate the clinical effects at the last follow-up.the changes of serum Creatine Kinase(CK)activity and C-Reactive Protein(CRP)concentration in two groups were compared pre-and postoperatively.Results:According to the modified Macnab criteria,the excellent and good rates in the two groups were 88.57%and 87.09%;the difference was not statistically significant(χ^(2)=0.034,P=0.855).There were no statistically significant difference between the two groups in age and gender(P>0.05).The intraoperative blood loss in the PEID group was less than that in the FD group.The incision length,operation time,postoperative bed time,and the duration of hospitalization in the PEID group were shorter than the FD group;the differences were statistically significant(P<0.05).VAS scores(back pain)in the PEID group at various postoperative time point were lower than those in the FD group(P<0.05).VAS(back-leg pain)score and ODI index of the two groups at various postoperative time point were lower than those before operation;the difference was

关 键 词：椎板间入路髓核摘除术 椎板开窗术 腰椎间盘突出症 微创 

分 类 号：R68[医药卫生—骨科学]