经皮内镜下腰椎间盘切除术和微创经椎间孔腰椎间融合术对腰椎间盘突出症的疗效对比观察  

Comparative observation of the efficacy of percutaneous endoscopic lumbar discectomy and minimally invasive ransforamtinal lumbar intervertebral fusion in the treatment of lumbar disc herniation

作　　者：邵旭宁 邵旭敏 赵宇 SHAO Xuning;SHAO Xumin;ZHAO Yu(Department of Critical Care Medicine,Zhengzhou Orthopaedic Hospital,Zhengzhou 450007,China)

机构地区：[1]郑州市骨科医院重症医学科,河南郑州450007

出　　处：《黑龙江医药科学》2025年第3期31-34,共4页Heilongjiang Medicine and Pharmacy

基　　金：河南省医学科技攻关计划(联合共建)项目,编号:LHGJ20191147。

摘　　要：目的:观察对腰椎间盘突出症患者行经皮内镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)和微创经椎间孔腰椎间融合术(minimally invasive transforaminal lumbar intervertebral fusion,MIS-TLIF)的疗效。方法:选取2020年12月至2022年5月在郑州市骨科医院重症医学科就诊的102例腰椎间盘突出症患者,将采用PELD治疗的51例患者列为PELD组,采用MIS-TLIF治疗的51例患者列为MIS-TLIF组。观察两组治疗效果、并发症状况,手术指标(手术时间、住院时间、术中出血量、切口大小)、影像学指标(椎间隙宽度、屈曲活动度、Cobb角)、不同时间疼痛程度[视觉模拟疼痛评分量表(VAS)]、腰椎状况[改良Oswestry功能障碍指数量表(ODI)]。结果:PELD组治疗总有效率与并发症发生率分别为98.04%、5.88%均高于MIS-TLIF组的96.08%、3.92%,差异无统计学意义(P>0.05)。PELD组患者伤口大小、手术时间、术中出血量、住院时间分别为0.88 cm、80.62 h、85.62 mL、7.06 d均少于MIS-TLIF组1.59 cm、112.65 h、150.64 mL、10.65 d(P<0.05)。治疗后,MIS-TLIF组椎间隙宽度、屈曲活动度分别为1.72 mm、31.62°均高于PELD组的1.52 mm、28.62°(P<0.05);MIS-TLIF组Cobb角为1.55°低于PELD组的2.05°(P<0.05)。治疗1、2周后,PELD组VAS评分分别为4.25分、2.13分均低于MIS-TLIF组的4.66分、2.51分(P<0.05)。治疗3、6个月后,PELD组ODI评分分别为20.52分、7.56分均低于MIS-TLIF组的22.41分、8.42分(P<0.05)。结论:腰椎间盘突出症患者采用PELD和MIS-TLIF治疗效果均较好,PELD手术指标、近期疼痛程度及腰椎功能均优于MIS-TLIF术,而MIS-TLIF后期腰椎影像学指标优于PELD治疗。Objective:To observe the efficacy of percutaneous endoscopic lumbar discectomy(PELD)and minimally invasive transforaminal lumbar intervertebral fusion(MIS-TLIF)in the treatment of patients with lumbar disc herniation.Methods:A retrospective analysis was conducted on 102 patients with lumbar disc herniation who were admitted to the Critical Care Medicine Department of Zhengzhou Orthopedic Hospital from December 2020 to May 2022.51 patients treated with PELD were classified as PELD group,and 51 patients treated with MIS-TLIF were classified as MIS-TLIF group.The treatment effects,complication rates,surgical indicators(operating time,length of hospital stay,intraoperative blood loss and incision size),radiological indicators(intervertebral space width,flexion range of motion and Cobb angle),pain severity at different time points(VAS),and lumbar spine status(ODI)were observed in both groups.Results:The total effective rate and complication rate in the PELD group were 98.04%and 5.88%,respectively,which were slightly higher than the 96.08%and 3.92%in the MIS-TLIF group,but the differences were not statistically significant(P>0.05).The incision size,operating time,intraoperative blood loss and length of hospital stay in the PELD group were 0.88 cm,80.62 hours,85.62 mL and 7.06 days,respectively,all of which were less than those in the MIS-TLIF group 1.59 cm,112.65 hours,150.64 mL and 10.65 days(P<0.05).After treatment,the intervertebral space width and flexion range of motion in the MIS-TLIF group were 1.72 mm and 31.62°,respectively,both higher than those in the PELD group 1.52 mm and 28.62°(P<0.05).The Cobb angle in the MIS-TLIF group was 1.55°,lower than the 2.05°in the PELD group(P<0.05).One and two weeks after treatment,the VAS scores in the PELD group were 4.25 and 2.13,respectively,both lower than those in the MIS-TLIF group 4.66 and 2.51(P<0.05).Three and six months after treatment,the ODI scores in the PELD group were 20.52 and 7.56,respectively,both lower than those in the MIS-TLIF group 22.41 and 8.42(P<0

关 键 词：经皮内镜下腰椎间盘切除术 微创经椎间孔腰椎间融合术 腰椎间盘突出症 疼痛程度 

分 类 号：R459.9[医药卫生—治疗学]