经椎间盘镜和椎间孔镜治疗腰椎间盘突出症的中远期疗效比较  

Comparison of MED and PTED in the Treatment of Lumbar Disc Herniation:Middle to Long Term Follow-up

作　　者：刘丰平[1] 赵红卫[1] 董军峰 张思胜[1] 罗茗刈[1] 卢斌[1] Liu Fengping;Zhao Hongwei;Dong Junfeng;Zhang Sisheng;Luo Mingyi;Lu Bing(Department of Spinal Surgery,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University&Institute of Spine and Trauma,China Three Gorges University,Yichang 443003,China)

机构地区：[1]三峡大学第一临床医学院[宜昌市中心人民医院]脊柱外科&三峡大学脊柱与创伤研究所,湖北宜昌443003

出　　处：《巴楚医学》2022年第1期55-59,共5页Bachu Medical Journal

基　　金：国家自然科学基金项目(No:31600779);宜昌市医疗卫生研究项目(No:A20-2-007)。

摘　　要：目的:比较椎间盘镜下髓核摘除术(MED)和经皮椎间孔镜椎间盘切除术(PTED)治疗腰椎间盘突出症(LDH)的中远期临床疗效。方法:回顾性研究我科2013年3月~2014年3月收治的80例单节段LDH患者临床资料,其中MED和PTED组各40例,平均随访5.6年,对两组患者中远期疗效进行比较。结果:在切口长度、出血量、术后卧床时间、术后住院时间、恢复工作时间上,PTED组均优于MED组(均P<0.05);而术中透视次数、手术时间MED组优于PTED组(均P<0.05)。术后各随访时间点,两组腰痛腿痛VAS和ODI评分均较术前改善(均P<0.01);末次随访时MED组和PTED组的改良MacNab标准评定优良率分别为95%和92.5%,差异无统计学意义(P>0.05)。随访期间PTED同一节段翻修3例,MED翻修2例。结论:MED和PTED均为LDH有效的微创术式,两者中远期疗效无明显差异。Objective:To compare the effects of microendoscopic discectomy(MED)and percutaneous transforaminal endoscopic discectomy(PTED)in the treatment of lumbar disc herniation(LDH)with a middle to long term follow-up.Methods:The clinical data of 80 patients with single segment LDH treated in our department from March 2013 to March 2014 were retrospectively studied,including 40 cases in MED and 40 cases in PTED group,with an average follow-up of 5.6 years.The medium and long-term curative effects of the two groups were compared.Results:The PTED group was superior to the MED group in terms of incision length,amount of bleeding,postoperative bed rest time,postoperative hospital stay and recovery time(all P<0.05).The mean frequency of intraoperative X-ray exposure and the operation time of MED were lower than PTED(both P<0.05).The VAS scores of low back and leg pain,as well as ODI score were improved at each follow-up time point in the two groups(all P<0.01).The excellent and good rates of the modified MacNAB criteria was 95%in the MED group,and 92.5%in the PTED group at the last follow-up,with no statistical difference between two groups(P>0.05).There were three re-operations in the PTED group,and two re-operations in the MED group in the same index disc.Conclusion:MED and PTED are both effective minimally invasive methods for LDH,without significant difference at medium to long-term efficacy between them.

关 键 词：腰椎间盘突出症 经皮椎间孔镜椎间盘切除术 椎间盘镜下髓核摘除术 

分 类 号：R681.53[医药卫生—骨科学]