经皮内窥镜下腰椎椎间盘切除术与椎板开窗椎间盘切除术治疗青少年腰椎椎间盘突出症

目的　比较经皮内窥镜下腰椎椎间盘切除术(PELD)与椎板开窗椎间盘切除术治疗青少年腰椎椎间盘突出症(LDH)的临床疗效。方法 2012年1月—2016年12月,海军军医大学附属长征医院收治青少年LDH患者82例,其中40例(A组)采用PELD治疗,42例(B组)采用椎板开窗椎间盘切除术治疗。记录并比较2组患者手术时间、术中出血量、术后卧床时间、咬骨体积,以及术前、术后1个月和末次随访时疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果所有手术顺利完成,所有患者随访12个月。A组手术时间、术中出血量、术后卧床时间及咬骨体积均低于B组,差异有统计学意义(P 0.05)。2组患者术后VAS评分和ODI均较术前明显改善,差异有统计学意义(P 0.05);组间比较术后VAS评分和ODI,差异均无统计学意义(P 0.05)。末次随访时MacNab疗效评定优良率A组为92.50%(37/40),B组为90.48%(38/42),差异无统计学意义(P 0.05)。A组并发症发生率为5.0%(2/40),B组为7.1%(3/42),差异无统计学差异(P 0.05)。结论 PELD可取得与传统椎板开窗椎间盘切除术相近的临床疗效,且可降低出血量,减少骨性结构破坏,缩短患者术后卧床及康复时间,是较为理想的治疗青少年LDH的微创方法。

Clinical comparison of percutaneous endoscopic lumbar discectomy and fenestration discectomy for adolescent lumbar disc herniation

Objective To compare the clinical effect of percutaneous endoscopic lumbar discectomy(PELD) and fenestration discectomy in the treatment of adolescent lumbar disc herniation(LDH). Methods From January 2012 to December 2016,82 adolescent LDH patients were admitted to Changzheng Hospital affiliated to Navy Medical University. Among them,40(Group A) were treated with PELD and 42(Group B) were treated with fenestration discectomy. The operation time,intraoperative blood loss,bed rest time,removal volume of bone,and visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation,postoperative 1 month and the final follow-up were recorded and compared between the 2 groups. Results All the operations were successfully completed. All the patients were followed up for >12 months. The operation time,intraoperative blood loss,bed rest time,removal volume of bone of group A were lower than those of group B,and the differences were statistically significant(P<0.05). Postoperative VAS score and ODI were significantly improved in both groups,with a statistical significance(P<0.05);there was no significant difference in VAS score and ODI at post-operation between the 2 groups(P>0.05). At the final follow-up,the excellent and good rate was 92.50%(37/40) in group A and 90.48%(38/42) in group B,without statistical significance(P>0.05). The incidence rate of complications was 5.0%(2/40) in group A and 7.1%(3/42) in group B,without statistical significance(P>0.05). Conclusion PELD can achieve similar clinical effect with the traditional fenestration discectomy,with reduced blood loss,reduced bone structural damage,short bed rest time and recovery time of patients,thus being an ideal minimally invasive treatment option for adolescent LDH.