经皮内窥镜腰椎间盘切除术与开放腰椎间盘摘除术治疗的临床对比研究

目的比较经皮内窥镜腰椎间盘切除术(PELD)和开放腰椎间盘摘除术(OLD)的临床疗效。方法对100例腰椎间盘突出症根据手术方法不同,分为PELD组和OLD组。手术效果按照Oswestry功能障碍指数(ODI)、疼痛视觉类比评分(VAS)和改良的MacNab标准评定。结果PELD组平均随访24.3个月,单个节段平均手术时间60min,失血11ml,术后卧床24h。OLD组平均随访24.5个月,单个节段平均手术时间50min,失血30ml,术后卧床120h。两组采用改良MacNab标准评定随访结果,PELD组优良率为92%,OLD组96%。PELD组和OLD组术后ODI、VAS与术前比较,明显改善(P<0.05)。结论在严格选择手术适应证的情况下,PELD和OLD具有相似的近期临床疗效,但是PELD具有切口小、创伤小和术后恢复较快等优点。

Clinically Comparative Study on Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Discectomy

Objective To compare the clinical effectiveness of percutaneous endscopic lumbar discectomy(PELD) with open lumbar discectomy(OLD).Methods In a prospective study,50 patients treated with PELD and 50 patients treated with OLD were compared.The Oswestry disability index(ODI),Visual analogue scale(VAS),modified MacNab criteria were employed to measure the clinical outcomes.Results PELD groups were followed for 24.3 months averagely.The result of PELD was as follows:operative time,60 minutes per single level;blood loss,11 ml;postoperative stay,24 hours.OLD groups were followed for 24.5 months averagely.The result of OLD were as follows: operative time,50 minutes per single level;blood loss,30 ml;Postoperative stay,120 hours.According to the modified Macnab criteria,92% of patients in PELD group showed excellent or good outcomes while 96% of patients in OLD group showed excellent or good outcomes.The improvement in VAS and ODI were statistically significant in the two groups(P<0.05).Conclusion The short surgical outcome of PELD for lumbar disc is similar to OLD if the patients are selected strictly according to the indications,but PELD has the advantages of smaller incision,less bleeding,less tissue trauma and quicker recovery.