PE-MFD与Endo-LOVE治疗腰椎间盘突出症疗效比较

目的比较内镜辅助椎间孔内口入路椎间盘摘除术(Percutaneous endoscopic medial foraminal discectomy,PEMFD)与全内镜下椎板开窗椎间盘摘除术(Full endoscopic fenestration discectomy,Endo-LOVE)治疗腰椎间盘突出症的临床疗效。方法回顾性分析自2016-12—2018-01诊治的78例腰椎间盘突出症,38例采用PE-MFD治疗(PE-MFD组),40例采用Endo-LOVE治疗(Endo-LOVE组)。比较2组手术时间、住院时间、术中透视次数、术中疼痛VAS评分以及术后1周、术后3个月、末次随访时疼痛VAS评分、ODI指数,比较2组末次随访时的临床疗效。结果 2组均顺利完成手术并获得完整随访,随访时间12~24个月,平均16个月。PE-MFD组手术时间较Endo-LOVE组少,术中透视次数较Endo-LOVE组多,术中疼痛VAS评分较Endo-LOVE组高,差异有统计学意义(P<0.05)。2组住院时间、术后1周、术后3个月、末次随访时的疼痛VAS评分以及ODI指数比较差异无统计学意义(P<0.05),末次随访时疗效按改良MacNab标准评价2组比较差异无统计学意义(P<0.05)。结论 PE-MFD与Endo-LOVE治疗腰椎间盘突出症早期都可取得显著疗效。相对于Endo-LOVE,PE-MFD手术时间较短,但患者术中舒适感较差。

Comparison of clinical effects between PE-MFD and Endo-LOVE in treatment of lumbar disc herniation

Objective To compare the clinical efficacy of percutaneous endoscopic medial foraminal discectomy(PE-MFD)and full endoscopic fenestration discectomy(Endo-LOVE)in the treatment of lumbar disc herniation.Methods Seventy eight cases of lumbar disc herniation diagnosed and treated from December 2016 to January 2018 were analyzed retrospectively.Thirty eight patients were treated with PE-MFD(PE-MFD group)and 40 patients with Endo-LOVE(Endo-LOVE group).The operation time,hospital stay time,the number of intraoperative fluoroscopy times,intraoperative visual analogue scale(VAS),VAS and Oswestry functional disability scale(ODI)at 1 week after the operation,3 months after the operation and the last follow-up were compared between the two groups,and the clinical effects were compared between the two groups during the last followup.Results The operation was completed successfully and complete follow-up was obtained in the two groups,with a followup period of 12-24 months(mean 16 months).The operation time of PE-MFD group was less than that of Endo-LOVE group,the number of times of intraoperative fluoroscopy was more than that of Endo-LOVE group,and the VAS score of intraoperative pain was higher than that of Endo-LOVE group.The differences in the above aspects were statistically significant(P<0.05).There was no significant difference in the hospital stay time,VAS and ODI at 1 week after the operation,3 months after the operation and the last follow-up between the two groups(P<0.05).At the last follow-up,there was no significant difference in the clinical effects between the two groups according to the modified MacNab criteria(P<0.05).Conclusion Both PE-MFD and Endo-LOVE are effective in the treatment of lumbar disc herniation in the early stage.Compared with Endo-LOVE,the operation time of PE-MFD is shorter,but the patients feel less comfortable during operation.