经皮椎间孔镜与椎板开窗椎间盘切除术治疗单节段单侧腰椎间盘突出症的对比研究

目的:探讨经皮椎间孔镜(PTED)与椎板开窗椎间盘切除术(FD)治疗单节段单侧腰椎间盘突出症(LDH)的临床疗效。方法:选取2015年1月-2016年12月来华北石油管理局总医院治疗的120例单节段单侧LDH患者,其中采用PTED术式治疗患者60例,作为PTED组,采用FD术式治疗患者60例,作为FD组。记录两组患者术中出血量、手术时间、切口长度、卧床时间、住院时间以及并发症发生率,比较两组患者术前、术后24 h、术后1周、术后3个月、术后6个月、术后12个月的视觉疼痛模拟(VAS)评分和Oswestry功能障碍指数(ODI)评分,并在术后12个月时采用MacNab疗效评定标准评价治疗效果。结果:PTED组患者在术中出血量、手术时间、切口长度、卧床时间、住院时间、并发症发生率均低于FD组(P0.05)。术后12个月PTED组患者VAS评分、ODI评分均低于FD组(P0.05),术后两组患者的VAS评分、ODI评分随着时间的推移越来越低,且与上一时间点相比均具有统计学差异(P0.05)。PTED组优良率为93.33%,与FD组的91.67%比较差异无统计学意义(P0.05)。结论:两种术式治疗LDH患者的疗效无差异,但是采用PTED术式手术时间短、术中出血量少、创伤小、术后并发症少,在减轻术后疼痛和改善生活能力方面优于FD术式。

Comparative Study on Percutaneous Transforaminal and Fenestration Discectomy in Treatment of Single Segmental Unilateral Lumbar Disc Herniation

ABSTRACT Objective: To investigate the clinical efficacy of percutaneous transforaminal endoscopic discectomy(PTED) and fen- estration discectomy (FD) in treatment of single segmental unilateral lumbar disc herniation(LDH). Methods: 120 patients with single segmental unilateral LDH who were treated in General Hospital of the North China Petroleum Administration from January 2015 to De- cember 2016 were selected. Among them, 60 cases were treated with PTED as PTED group, and 60 cases were treated with FD as FD group. The amount of intraoperative bleeding, operation time, incision length, bed rest time, hospitalization time and complication rate of the two groups were recorded, visual analogue scale (VAS) score and Oswestry disability index(ODI) score of two groups were compared before operation and 24 h, 1 week, 3 months, 6 months and 12 months after operation, and the therapeutic effect was evaluated by the MacNab evaluation standard at 12 months after operation. Results: The amount of intraoperative bleeding, operation time, incision length, bed rest time, hospitalization time and complication rate in PTED group were significantly lower than those in FD group(P<0.05). The VAS score and ODI score in PTED group at 12 months after operation were lower than that in FD group(P<0.05). After operation, the VAS score and the ODI score of the two groups were smaller and smaller with the time, and there were statistically significant differ- ences compared with the previous time points (P<0.05). The excellent and good rate of PTED group was 93.33%, and there was no statis- tical difference compared with 91.67% of FD group (P>0.05). Conclusion: There is no difference in the efficacy of two kinds of surgical treatment for LDH patients, but PTED operation has shorter operative time, less intraoperative blood loss, less trauma and fewer postop- erative complications. It is better than FD in relieving postoperative pain and improving life ability.