不同麻醉下经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症的疗效观察

目的探讨和分析不同麻醉下经皮椎间孔镜髓核摘除术在腰椎间盘突出症(LDH)患者中的临床应用价值。方法选取2016年1月-2017年12月该院所收治的110例LDH患者作为临床研究对象,采用随机数字表法将入选研究对象随机分为观察组56例和对照组54例,两组患者均行经皮椎间孔镜髓核摘除术治疗,研究组给予腰硬联合麻醉方案,对照组则给予气管插管全麻方案,并分别对两组患者的蒙特利尔认知评估量表(MoCA)、简易精神状态检查量表(MMSE)、视觉模拟评分(VAS)、Oswestry功能障碍指数问卷表(ODI)及临床治疗情况进行比较和分析。结果观察组术后MoCA评分(28.25±3.94)分和MMSE评分(29.72±4.08)分明显高于对照组,差异均有统计学意义(P 0.05);术后VAS评分(2.97±0.40)分和ODI指数(20.54±3.16)%明显低于对照组,差异均有统计学意义(P 0.05);术后临床治疗效果达到优的比率66.07%(37/56),以及总的优良率94.64%(53/56)明显高于对照组,差异有统计学意义(P 0.05)。结论腰硬联合麻醉下经皮椎间孔镜髓核摘除术对LDH患者认知功能的改善、疼痛症状的缓解和临床治疗效果的提升均有积极的现实意义。     

Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report

BACKGROUND Percutaneous endoscopic lumbar discectomy(PELD)has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation(LDH).Repeated fluoroscopy,with more than 30 shots on average,is inevitable to ensure its accuracy and safety.However,exposure to X-rays may pose a threat to human health.We herein report a case of ultrasound(US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.CASE SUMMARY A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic,his symptoms had aggravated for 1 month,and he was diagnosed with L3-4 and L4-5 disc herniations.He received US-guided PELD with good results:His straight leg elevation increased from 40 to 90 degrees after PELD,and his visual analog scale(VAS)and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD.With the guidance of US,he received only two shots of fluoroscopy(fluoroscopic time:4.4 s;radiation dose:3.98 mGy).To our knowledge,this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.CONCLUSION US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.     

Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review

ObjectivePediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for pediatric LDH and the degree of lumbar disc degeneration at 1 year after PELD.MethodsWe retrospectively reviewed the data of pediatric patients with LDH who underwent PELD from December 2007 to July 2018. The patients’ symptoms, physical examination findings, clinical images, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), and perioperative results (blood loss, length of hospital stay, and complications) were obtained from the medical records. Lumbar disc degeneration was graded using the modified Pfirrmann grading system at the 1-year postoperative magnetic resonance imaging (MRI) examination.ResultsSix boys and four girls who underwent PELD were evaluated. The patients’ mean age was 15.6 years (range, 13–17 years). The mean VAS score for low back pain, mean VAS score for lower limb pain, and mean ODI preoperatively and 1 year postoperatively were 6.2 and 0.3, 6.9 and 0.5, and 20 and 0.1, respectively. MRI showed significant disc degeneration after PELD.ConclusionsTreating pediatric LDH with PELD is safe and effective. It relieves pain and reduces disability. However, lumbar disc degeneration still occurs.     

1007-1989（2016）01-0032-05

目的探讨经皮椎间孔镜治疗单节段腰椎间盘突出症的临床疗效。方法选择2013年2月-2014年1月收治的60例采用经皮椎间孔镜治疗的单节段腰椎间盘突出症患者,根据术前、术后1 d、术后3及6个月患者疼痛视觉模拟评分(VAS)及改良的MacNab标准评价临床疗效。结果 60例患者手术均顺利完成,手术时间平均(65.00±12.00)min,无硬膜囊破裂、神经根及血管损伤、感染等并发症。术后1例患者症状改善不明显,改行开放性手术后缓解。余病例腰腿痛症状较前均明显缓解,并获6~12个月随访,术后2个月行腰椎磁共振成像(MRI)检查证实突出髓核组织均切除彻底,神经根及硬膜囊受压解除。术后6个月随访,腰痛VAS评分术前术后差值的均数及标准差为(4.42±1.45)分,腿痛VAS评分术前术后差值的均数及标准差为(6.49±1.67)分,差异均具有统计学意义(P0.05)。根据改良的MacNab标准,优31例;良20例;可7例;差1例,优良率86.4%。结论经皮椎间孔治疗单节段腰椎间盘突出症具有手术时间短、创伤小和临床效果确切等优点。     

Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis,herniated nucleus pulposus and pulmonary comorbidities

A 70‐year‐old man with severe pulmonary comorbidities was referred to our institution for treatment of a right L5 nerve impingement. He had suffered from spinal canal stenosis and herniated nucleus pulposus (HNP) at the level of L4‐L5 for more than a year and had been treated conservatively. However, the pain could not be alleviated, and his primary care physician scheduled posterior decompression surgery. During this procedure, the anesthesiologist refused to induce general anesthesia because of the patient's very poor pulmonary condition. Subsequently, the patient was referred to us. We used a transforaminal approach with percutaneous endoscopic discectomy, with the patient under local anesthesia. First, herniated nucleus pulposus fragments at the disc level were removed. With a trephine drill, the upper part of the L5 pedicle was removed, which allowed for the extraction of dorsally migrated fragments. Following complete removal of the herniated nucleus pulposus fragments, osseous decompression was performed. The osseous endplate of L5 (anterior part of the lateral recess) was removed to enlarge the lateral recess so that decompression of the L5 nerve root was possible. The patient's lower back pain and right leg pain subsided following surgery. Percutaneous endoscopic discectomy is useful for patients with severe comorbidities as it can be done with local anesthesia.     

Spontaneous regression of a large sequestered lumbar disc herniation: a case report and literature review

Lumbar disc herniation is a common disorder in adults that is accompanied by lower back and radicular pain. A 32-year-old man visited our clinic with 1-week history of persistent lower back pain and weakness in his right big toe. Magnetic resonance imaging (MRI) of his lumbar spine revealed herniated discs at L3/L4, L5/S1 and L4/L5, where a right-sided intraspinal mass lesion deep to the L4 vertebral body was causing compression of the nerve root. The patient underwent conservative treatment and reported no symptoms referrable to his back or leg 4 months later. Follow-up MRI showed no herniation of the nucleus pulposus at the L4/L5 level or lesion deep to the vertebral body of L4, whereas no changes had occurred to the status of the herniated L3/L4 and L5/S1 discs. The present case and a literature review show that a sequestered lumbar disc herniation can regress within a relatively short timeframe without surgery. The authors emphasise the utility of conservative therapy for patients who do not have a definitive surgical indication.     

Minimally invasive and simultaneous removal of herniated intracanal and extracanal lumbar nucleus pulposus with a percutaneous spinal endoscope

Herniated nucleus pulposus (HNP) in the lumbar spine is usually found in the neural canal (in the intracanal space) and occasionally in the extracanal space, where it is known as a lateral HNP. HNP is rarely found simultaneously in both spaces. However, we experienced such a case in a 48‐year‐old man who presented with right leg pain and lower back pain that had lasted for more than a year. MRI revealed HNP in both the right intracanal and extracanal spaces at L2‐L3. A transforaminal approach was used to complete a percutaneous endoscopic discectomy. An 8‐mm incision was made with the patient under local anesthesia, and the percutaneous endoscope was inserted at the affected disc space. First, the HNP fragments in the intracanal space were removed, and then the cannula and endoscope were extracted to the extracanal space where the extracanal fragments were removed. Two hours after the surgery, the patient stood and walked. Right leg pain and lower back pain had disappeared. Unlike other techniques such as Love's procedure and the microendoscopic discectomy technique, the use of a transforaminal approach with the percutaneous endoscopic technique enables the HNP fragments in the intracanal and extracanal spaces to be removed at the same time with a single approach.     

全脊柱内镜下治疗极外侧型腰椎间盘突出症的疗效评价

目的评估经皮全脊柱内镜下腰椎间盘切除术(PELD)治疗极外侧型腰椎间盘突出症(FLDH)的临床疗效。方法回顾性分析2014年6月-2015年9月该科采用经皮全脊柱内镜技术治疗FLDH 27例,年龄41~64岁,平均52.3岁,通过观察手术时间、术中出血量和住院时间,采用视觉模拟评分(VAS)评估术前及术后患者腰腿痛情况,改良Mac Nab评分评估患者腰部功能恢复情况。结果单节手术时间为69 min(58~109 min)、术中出血量为18 ml(11~40 ml)、住院时间为5.0 d(3.0~10.0 d),术前VAS评分(8.12±1.25),术后第3天VAS评分(2.80±1.12),术后3个月VAS评分(1.59±1.06),末次随访VAS评分(1.31±0.89),术后VAS评分与术前相比差异均有统计学意义(P0.05)。采用改良Mac Nab标准评估,优良率为88.9%。结论 PELD治疗FLDH具有创伤小、恢复快等优点,是一种安全、有效的微创手术。     

经皮椎间孔镜技术与显微镜辅助治疗腰椎间盘突出症的临床疗效分析

目的 对比分析经皮椎间孔镜技术与显微镜辅助治疗腰椎间盘突出症的临床效果。方法 采用随机数表法,将2017年10月-2019年12月该院收治的60例腰椎间盘突出症患者随机分为：采用经皮椎间孔镜治疗的试验组和采用显微镜辅助治疗的对照组,每组30例。术后分析两组患者的临床治疗效果。结果试验组手术时间和住院时间均短于对照组,切口长度短于对照组,术中出血量少于对照组（P <0.05）;术后1周,试验组视觉模拟评分（VAS）低于对照组,日本骨科学会（JOA）评分高于对照组（P <0.05）;两组患者临床优良率、术后1和3个月VAS和JOA评分比较,差异均无统计学意义（P> 0.05）;对照组术中发生1例硬膜囊撕裂,采用可吸收线修补。其余患者术中及术后均无并发症发生。结论 经皮椎间孔镜技术可有效缩小手术切口,减少术中失血量,减轻短期疼痛,促进患者腰椎功能恢复,且不增加患者并发症发生率,值得临床推广应用。     

经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症的疗效观察

目的:评价应用经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症的疗效观察。方法:自2010年9月~2011年12月间,应用经皮椎间孔脊柱内窥镜下技术,治疗腰椎间盘突出症277例(340个椎间盘)。采用患者腰腿痛进行视觉模拟疼痛评分(visual analogue scale,VAS)和Macnab标准评定手术疗效。结果:本组无术中硬脊膜撕裂和血管、神经损伤等并发症。3例患者术后下肢表现一过性痛觉过敏,经对症治疗2周后症状消失。平均手术时间45 min(30~70 min),平均下床时间6 h(3~12 h),平均住院时间7 d(5~15 d),随访时间4~13个月,平均6.8个月。下肢神经支配区域使用VAS评分,术前8.8±1.0分,术后5 d为2.5±1.4分,末次随访时1.3±1.2分;术前、术后对比,结果有统计学差异(P<0.01)。参照Macnab疗效评定标准,优211例,良54例,可12例,差0例,优良率95.8%。结论:经皮椎间孔脊柱内窥镜下技术治疗腰椎间盘突出症具有创伤小、出血少、恢复快、并发症少、疗效确切的优点。该技术是微创治疗腰椎间盘巨大突出、脱出、游离型椎间盘突出症的最佳方法之一。     

半椎板切除髓核摘除术与椎板开窗髓核摘除术治疗腰椎间盘突出症的远期疗效比较

目的比较半椎板切除髓核摘除术与椎板开窗髓核摘除术治疗腰椎间盘突出症的远期疗效。方法选取我院2006年8月至2010年4月收治的80例腰椎间盘突出症患者为研究对象,采用信封法分为Ⅰ组(40例,半椎板切除髓核摘除术)和Ⅱ组(40例,椎板开窗髓核摘除术)。比较两组的ODI、SF-MPQ、腰部活动障碍评分量表评分、临床病情控制优良率及随访10年的复发率。结果随访5、10年,Ⅱ组的ODI、SF-MPQ、腰部活动障碍评分量表评分均明显低于Ⅰ组,Ⅱ组的临床病情控制优良率明显高于Ⅰ组(P<0.05)。随访10年,Ⅱ组的复发率明显低于Ⅰ组(P<0.05)。结论椎板开窗髓核摘除术治疗腰椎间盘突出症的远期效果显著,能更有效地改善腰椎功能,提升腰部活动能力,减轻疼痛,降低复发率。     

靶向椎间孔成形减压术治疗游离型腰椎间盘突出合并神经根管狭窄症

目的探讨经皮椎间孔镜下行靶向椎间孔成形减压术治疗游离型腰椎间盘突出合并神经根管狭窄症的临床疗效。方法选取2016年10月-2017年12月赤峰市医院脊柱外科收治的30例游离型腰椎间盘突出合并神经根管狭窄症患者。所有患者均在经皮椎间孔镜下行靶向椎间孔成形减压术。记录术前1 d、术后2 d及术后3个月患者腰痛与腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),术后2 d及术后3个月采用改良Macnab标准评估手术疗效。结果所有患者均顺利完成治疗,手术时间为65~200 min,平均90 min。术中出血量为15~135 ml,平均55 ml。卧床时间均不超过24 h,平均住院日为5 d。术前1 d腰痛及腿痛VAS评分为(6.57±1.96)和(7.03±1.75)分,术后第2天腰痛及腿痛VAS评分为(2.03±0.96)和(1.97±1.07)分,术后3个月腰痛及腿痛VAS评分为(1.83±0.95)和(1.77±1.04)分,术前1 d、术后2 d及术后3个月ODI指数分别为(70.42±3.55)%、(22.56±0.72)%和(22.69±0.70)%。可以看出术后3个月和术后2 d较术前1 d各项指标均有改善,差异有统计学意义(P 0.05)。应用改良Macnab标准评定疗效,在临床疗效上,术后3个月患者的优良率为96.67%。明显优于术后2 d的优良率73.33%,两组比较差异有统计学意义(P 0.05)。结论经皮椎间孔镜下靶向椎间孔成形减压术是治疗游离型腰椎间盘突出合并神经根管狭窄症的微创、有效、安全的手术方式之一。     

经皮椎间孔镜技术对腰椎间盘突出症患者的疗效及对机体氧化应激水平的影响

目的:探讨经皮椎间孔镜技术在腰椎间盘突出症患者中的应用效果及对其一氧化氮(NO)、过氧化物岐化酶(SOD)水平的影响。方法:选择2017年1月至2020年6月诊治为腰椎间盘突出症的136例患者,按随机数字表法分为2组,各68例。对照组采用椎板开窗手术治疗,观察组采用经皮椎间孔镜技术治疗,术后1个月评估疗效。比较两组患者的Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、JOA腰椎评分(JOA)、直腿抬高角度、NO、SOD、炎性因子及并发症发生率。结果:观察组治疗后1个月ODI、VAS评分低于对照组(P0.05),JOA及直腿抬高角度高于对照组(P0.05)。观察组治疗后1个月NO、SOD水平升高,但治疗后3个月低于对照组(P0.05),治疗后1个月IL-6、hs-CRP水平低于对照组(P0.05)。观察组与对照组术后感染、切口愈合不良、感觉功能改变、血肿及脏器损伤发生率差异无统计意义。结论:与椎板开窗手术相比,经皮椎间孔镜技术能更好地改善腰椎间盘突出症患者的腰椎功能、减轻疼痛、降低氧化应激反应和炎性因子水平,手术安全性较高,值得推广应用。     

改良经皮椎间孔脊柱内镜技术、经皮椎间孔镜椎间盘切除术治疗腰椎间盘突出症的效果比较

目的 比较改良经皮椎间孔脊柱内镜技术、经皮椎间孔镜椎间盘切除术(PTED)治疗腰椎间盘突出症的效果.方法 选取2018年1月至2019年9月我院收治的69例腰椎间盘突出症患者作为研究对象,根据非随机同期对照研究及自愿原则将其分为A组(35例)和B组(34例).A组给予改良经皮椎间孔脊柱内镜技术治疗,B组给予PTED治疗...     

非手术脊柱减压系统治疗腰椎间盘突出症的疗效观察

目的：观察非手术脊柱减压系统对腰椎间盘突出症患者腰痛、腰椎活动功能和椎旁肌功能,以及腰椎间盘突出程度和椎间盘高度的疗效观察。方法：将40例腰椎间盘突出症（LDH）患者随机分为牵引组和非手术脊柱减压系统（SDS）组各20例。牵引组在常规康复治疗基础上予普通牵引治疗,SDS组在常规康复治疗基础上予SDS治疗。治疗前后,用视觉模拟（VAS）评分量表评估2组患者腰痛程度,日本骨科学会（JOA）下腰痛量表评估腰椎活动功能,表面肌电图评估椎旁肌功能,美国超导型核磁共振评估椎间盘突出指数（DHI）和椎间盘高度（DH）。结果：治疗6周后,2组患者VAS评分均明显低于治疗前（均P<0.05）,JOA评分均明显高于治疗前（均P<0.05）;SDS组VAS评分明显低于牵引组（P<0.05）,JOA评分明显高于牵引组（P<0.05）。2组患侧竖脊肌和多裂肌平均肌电值（AEMG）均明显高于治疗前（均P<0.05）;SDS组平均肌电值AEMG明显高于牵引组（P<0.05）。2组患者患侧竖脊肌和多裂肌平均功率频率斜率（MPFs）均明显高于治疗前（均P<0.05）,SDS组MPFs明显高于牵引组（P<0.05）。2组患者病变节段DHI均明显低于治疗前（均P<0.05）,DH明显高于治疗前（均P<0.05）;SDS组DHI明显低于牵引组（P<0.05）,但2组DH比较,差异无统计学意义。结论：SDS能明显减轻腰痛,改善LDH患者腰椎活动功能、椎旁肌功能和腰椎间盘突出程度,疗效优于普通牵引。     

Dynesys与Wallis系统治疗单节段腰椎间盘突出症的长期疗效及安全性

目的探讨单节段腰椎间盘突出症患者应用椎弓根螺钉Dynesys系统、棘突间Wallis系统治疗的有效性及安全性。方法 60例腰椎间盘突出症患者随机分为2组,Dynesys组30例采用椎弓根螺钉Dynesys系统治疗,Wallis组30例采用棘突间Wallis系统治疗。记录2组手术时间、术中出血量、住院时间。随访8年,记录术前及术后1、3、12个月腰、腿痛视觉模拟评分(visual analogue scale, VAS);比较术前及术后1、3、5、8年日本骨科协会(Japanese Orthopaedic Association, JOA)评分及Oswestry功能障碍指数(Oswestry Disability Index, ODI);比较术前及术后4、8年手术节段及邻近节段椎间活动度(range of motion, ROM)、椎间隙高度;统计随访期间腰椎间盘突出症复发、棘突骨折以及内固定失败等并发症发生情况。结果 Dynesys组手术时间、住院时间较Wallis组长,术中出血量较Wallis组多(P<0.05)。2组术后1、3、12个月腰痛、腿痛VAS评分均较术前降低(P<0.05),2组间比较差异均无统计学意义(P>0.05)。2组术后1、3、5、8年ODI均较术前降低,JOA评分较术前增高(P<0.05);2组术后4、8年手术节段ROM均较术前降低(P<0.05),椎间隙高度与术前比较差异无统计学意义(P>0.05);术后4、8年邻近节段椎间隙高度、ROM与术前比较差异无统计学意义(P>0.05);以上数据2组间比较差异均无统计学意义(P>0.05)。Dynesys组1例术后8年邻近节段发生退变,无任何临床症状;Wallis组1例术后6年腰椎间盘突出症复发,行后路融合内固定术后症状缓解,末次随访时未见复发。结论 Dynesys与Wallis系统治疗单节段腰椎间盘突出症均可维持手术节段椎间隙高度,保留手术节段一定的活动度,对邻近节段影响较小。     

经皮椎间孔镜治疗腰椎间盘突出症的疗效分析

目的探讨经皮椎间孔镜技术(PTED)在治疗经保守治疗无效的腰椎间盘突出症中的临床应用价值。方法选择单节段椎间盘突出症经保守治疗无效患者50例,随机分成两组:经椎间孔镜下行椎间盘髓核摘除术25例(观察组),传统开放手术25例(对照组),对比两种手术治疗腰椎间盘突出症的临床疗效。结果手术进展顺利,术后两组患者腰痛症状均缓解。观察组患者手术切口大小、出血量、术后卧床时间较对照组少(P0.05),手术时间两组无统计学差异(P0.05)。患者均随访3个月,两组患者手术治疗1个月与3个月JOA评分相比无显著差异,两组均无硬脊膜破裂、神经根损伤等并发症,仅对照组1例对照组患者术后当天出现一过性神经麻痹,对症处理后症状逐渐缓解。结论与传统开放治疗相比,经皮椎间孔镜技术治疗椎间盘突出症疗效相当,但具有创伤小、恢复快等优点,是一项有效的治疗手段。     

经皮脊柱内镜椎板间隙入路治疗微小腰椎间盘突出症的短期临床观察

目的 探讨椎板间隙入路经皮脊柱内镜腰椎间盘摘除术（PELD）治疗微小腰椎间盘突出症（MLDH）的临床效果。方法 回顾性分析2019年1月-2020年1月该院收治的12例MLDH患者的临床资料,均使用PELD进行治疗。分析术前1 d和术后不同时间点的视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评分,并且采用MacNab标准对末次随访进行疗效评估。结果 随访时间（12.1±2.6）个月,手术时间（45.5±8.5） min。术后1 d、术后1个月、术后3个月和末次随访时的VAS和ODI评分均较术前明显改善（P <0.05）。Macnab疗效评定：优9例,良3例。结论 椎板间隙入路PELD治疗MLDH,创伤小,症状改善明显,具有较好的临床效果。     

温针灸治疗腰椎间盘突出症的临床效果

目的温针灸治疗腰椎间盘突出症的临床效果。方法将64例血瘀型腰椎间盘突出症患者按照随机数字表法分为对照组和观察组,各32例。对照组给予常规针灸治疗,观察组取穴与对照组相同,给予温针灸。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,两组的VAS评分、IL-6、NO水平均降低,JOA下腰痛评分均升高,且观察组优于对照组(P<0.05)。结论温针灸治疗腰椎间盘突出症的效果显著,可改善患者的临床症状,减轻疼痛和炎症反应。     

经皮椎间孔镜与开放椎板间开窗术治疗腰椎间盘突出症的疗效分析*

目的评价经皮椎间孔镜椎间盘切除术(PTED)与传统开放椎板间开窗术两种手术方式治疗经保守治疗无效的腰椎间盘突出症患者的近期临床疗效。方法回顾分析两种单节段手术患者30例,其中16例患者行PTED术,14例行椎板间开窗术,记录两组术前、术后资料,包括性别、年龄、病程、手术节段、手术时间、出血量和卧床时间等,于术前、术后1周、术后1个月和术后大于6个月的随访行疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数评定(ODI),并按中华骨科学会脊柱学组腰背痛手术评分标准评价两组手术临床疗效,所得以上结果进行统计学分析。结果两组患者均随访,平均随访时间28.4个月,对两种手术疗效进行比较,比较两组的出血量、卧床时间和手术时间差异有统计学意义(P0.05);两组术后1个月、末次随访VAS及ODI评分差异均无统计学意义(P0.05);末次随访PTED组优良率为87.50%,传统开窗组优良率为71.42%,两组疗效优良率比较差异无统计学意义(P0.05)。结论 PTED是传统手术的微创化,其结合传统术式与经皮穿刺技术的优势能直接到达突出椎间盘位置,摘除病变髓核,直接解除椎管内压迫,在减少手术创伤的同时,达到与传统术式相似的疗效,可作为治疗腰椎间盘突出症的有效可靠术式。