经皮椎间孔镜与Mast Quadrant通道技术治疗腰椎间盘突出症临床疗效比较

目的:研究和比较经皮椎间孔镜(Percutaneous Transforaminal Endoscopic Discectomy,PTED)与Mast Quadrant通道技术治疗腰椎间盘突出症(Lumbar disc herniation,LDH)的临床疗效及安全性。方法:回顾性分析2008年至2015年在本院接受手术治疗的单节段LDH患者90例,其中接受经皮椎间孔镜椎间盘突出髓核摘除术(PTED)患者58例,接受Mast Quadrant通道系统下腰椎间盘切除术患者32例,按手术方式的不同分为PTED组与Quadrant组。结合随访资料,评价并比较两组病例手术时间、术中出血量、术后住院天数、并发症发生情况。手术效果按照视觉疼痛模拟评分(VAS)、0swestry功能障碍指数(ODI)和改良Mac Nab标准进行评定。结果:椎间孔镜组术中出血量、术后住院天数、并发症发生率、术后1天、7天腰痛VAS评分及ODI均优于Quadrant组(P0.05);椎间孔镜组手术时间长于Quadrant组(P0.05);两组术后腿痛VAS评分、手术优良率比较差异无统计学意义(P0.05)。结论:经皮椎间孔镜与Mast Quadrant通道技术均能有效治疗腰椎间盘突出症,在严格掌握手术适应证和禁忌症的前提下,经皮椎间孔镜手术能够明显减少出血及并发症,是一种治疗腰椎间盘突出症理想的微创手术方式,但长期疗效有待进一步临床研究。

Comparison of the Clinical Efficacy of Percutaneous Transforaminal Endoscopic Discectomy and Mast Quadrant Channel Technique in the Treatment of Lumbar Disc Herniation

ABSTRACT Objective: To compare the clinical effect and safety of percutaneous transforaminal endoscopic discectomy(PTED) and Mast Quadrant channel technique in the treatment of lumbar disc herniation(LDH). Methods: 90 cases of patients with lumbar disc herniation treated from 2008 to 2015 were retrospectively reviewed, in which 58 patients were treated by PTED and 32 patients were treated by Mast Quadrant channel technique. All patients were divided to PTED group and Quadrant group. The clinical outcomes were evaluated and compared by operation time, blood loss, postoperative hospital stay and intraoperative complications. The surgical results were evaluated according to the Visual Analogue Scale(VAS), Oswestry Disability Index(ODI), and modified MacNab criteria. Results: The blood loss, postoperative hospital stay, intraoperative complications, the VAS score and ODI of lumbar pain in one days and one weeks after operation were shorter or lower in PTED group compared with the Quadrant group(P<0.05). The operation time were shorter in Quadrant group compared with the PTED group(P<0.05); The postoperative VAS score of leg pain and MacNab criteria excellent rate had no significant difference between the two groups(P>0.05). Conclusion: Under the premise of mastering the indications and contraindications. Both PTED and Mast Quadrant are effective in the treatment of LDH. PTED had obvious advantages of some aspects and reduce bleeding and complications, which is an ideal minimally invasive for treating LDH. but the long-term outcomes should be further studied clinically.