椎间孔镜下关节突可视化成型技术和显微镜微创通道技术治疗腰椎间盘突出症的临床疗效对比  

Clinical efficacy of visualization of percutaneous transforaminal endoscopic discectomy and minimally invasive tubular microdiscectomy in treatment of lumbar disc herniation

作　　者：殷梦泽 李晋虎 陈毅[2] 范益民[2] 王宏勤 郑安潮[2] 刘晓东[2] YIN Meng-ze;LI Jin-hu;CHEN Yi;LIU Xiao-dong(First Clinical Medical College,Shanxi Medical University,Taiyuan 030001,China;不详)

机构地区：[1]山西医科大学第一临床医学院,太原030001 [2]山西医科大学第一医院神经外科

出　　处：《临床神经外科杂志》2023年第1期36-41,共6页Journal of Clinical Neurosurgery

基　　金：山西省重点研发计划基金资助项目(201903D321045);山西省应用基础研究计划项目(201901D211478);山西省教育厅高校科技创新计划基金资助项目(2020L0200)。

摘　　要：目的 比较椎间孔镜下关节突可视化成型技术(VPTED)和显微镜微创通道技术(MITM)治疗单节段腰椎间盘突出症患者的临床疗效。方法 回顾性分析山西医科大学第一医院神经外科2019年10月1日—2021年10月31日期间收治的64例行手术治疗单节段腰椎间盘突出症患者的临床资料,其中采用VPTED治疗30例,采用MITM治疗34例。比较两组手术时间、术后住院时间、住院总费用及术后并发症、采用疼痛视觉模拟评分(VAS)和Oswestry残障指数(ODI)评价手术疗效并进行统计学分析。结果 VPTED组相比于MITM组,手术总时间及术后住院时间更短[(80.4±19.5)min/(111.5±25.2)min(P<0.05),(2.5±1.3)d/(4.2±2.3)d](P<0.05)。两组住院总费用相近,差异无统计学意义。两组术后各时间点VAS评分及ODI评分较术前均有下降(P<0.01);两组间术后各时间点VAS评分及ODI评分随访结果差异均无统计学意义(P>0.05)。MITM组患者术后复发1例,两组患者各有1例术后切口愈合不良。结论 椎间孔镜下关节突可视化成型技术和显微镜微创通道技术相比治疗腰椎间盘突出症均具有微侵袭、并发症低、花费低及相似的临床疗效。椎间孔镜下关节突可视化成型技术手术总时间更短,术后住院时间更短。但对于如突出髓核钙化严重、高髂嵴的患者建议采用显微镜微创通道下腰椎间盘切除术。Objective To investigate the clinical efficacy of visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and minimally invasive tubular microdiscectomy(MITM) for patients with single-segment lumbar disc herniation(LDH). Methods The clinical data of 64 patients with single-segment LDHn admitted to Department of Neurosurgery, the First Hospital of Shanxi Medical University from October 1, 2019 to October 31, 2021 were analyzed retrospectively. Among 64 patients, 30 patients were treated with VPTED and 34 were treated with MITM. The surgical time, the length of hospital stay after operation, total hospitalization cost, postoperative complications, visual analog scale(VAS) and oswestry disability index(ODI) were compared and statistically analyzed. Results The total operative time and the hospital stay after operation were shorter in the VPTED group than the MITM group[(80.4±19.5)min/(111.5±25.2)min(P<0.05),(2.5±1.3) d/(4.2±2.3) d](P<0.05). There was no significant difference between the two groups in terms of the total hospitalization cost(P>0.05). VAS scores and ODI scores of the two groups were decreased at all time points after operation compared with those before operation Ⅰ( P < 0. 01). There was no significant difference in VAS score and ODI score between the two groups at all time points after operation( P > 0. 05). There were one case of postoperative recurrence in the MITM group,and two cases of poor incision healing in each of the two groups. Conclusions In the treatment of lumbar disc herniation,the VPTED and MITM have the advantages of minimal-invasion,low complications,low cost and similar clinical efficacy. The total operation time and postoperative hospital stay of VPTED is shorter. However,for patients with severe calcification of the protruding nucleus pulposus and high iliac crest, MITM is recommended.

关 键 词：腰椎间盘突出症 椎间孔镜 微创通道 可视化 

分 类 号：R651[医药卫生—外科学]