经皮脊柱内镜两种入路治疗L5S1椎间盘突出症的疗效分析

目的：分析经皮椎间孔入路内镜下髓核摘除术（percutaneous endoscopic transforaminal discectomy，PETD）与经皮椎板间入路内镜下髓核摘除术（percutaneous endoscopic interlaminar discectomy，PEID）治疗L₅S₁椎间盘突出症的临床疗效、并发症及术中操作要点。方法：对2015年7月至2018年3月收治的158例L₅S₁椎间盘突出症患者的临床资料进行回顾性分析。按手术入路不同分为PETD组和PEID组，每组79例。PETD组男41例，女38例，年龄（41.38±6.25）岁，病程（10.06±3.14）个月；PEID组男43例，女36例，年龄（41.18±5.78）岁，病程（9.99±2.83）个月。记录两组患者的手术时间、术中出血量、X线放射次数、住院天数及并发症发生情况；采用目测类比评分、JOA评分、ODI指数、改良Macnab评定标准对疗效进行评定。结果：所有患者顺利完成手术并获得1年随访。（1）两组患者术中出血量、住院时间比较差异无统计学意义（P>0.05）；手术时间、X线放射次数PETD组均明显高于PEID组（P<0.05）。（2）与术前相比，术后1周，6、12个月目测类比评分、ODI指数、JOA评分两组均明显改善（P<0.05），组间比较差异无统计学意义（P>0.05）。（3）末次随访PETD组优良率89.87%（71/79），PEID组为87.34%（69/79），组间比较差异无统计学意义（P>0.05）。（4）PETD组发生2例并发症，PEID组出现3例，组间比较差异无统计学意义（P>0.05）。结论：PETD与PEID治疗L₅S₁椎间盘突出症短期疗效相当，而在手术时间、穿刺定位难度、X线放射次数方面，PEID更具优势。通过严格把握适应证，熟练内镜技术、精细术中操作，熟悉常见并发症的注意要点，可有效减少并发症发生。

Analysis on clinical effects of two surgical approaches in percutaneous spinal endoscopy for L5S1 disc herniation

Objective: To analyze the clinical effects,complications and operational key points of the percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating L₅S₁ disc herniation.Methods: The clinical data of 158 patients with L₅S₁ disc herniation treated from July 2015 to March 2018 were restospectively analyzed. According to different surgical approaches,the patients were divided into PETD group or PEID group,79 cases in each group. In PETD group,there were 41 males and 38 females,with an average age of(41.38±6.25) years and course of disease of(10.06±3.14) months. In PEID group,there were 43 males and 36 females,with an average age of (41.18±5.78) years and course of disease of (9.99±2.83) months. The operation length,intraoperative blood loss,intraoperative fluoroscopy times,days of hospital stay,and complications were recorded between two groups. Visual analogue score(VAS),Japanese Orthopedic Association(JOA) score,Oswestry Disability Index(ODI),modified Macnab criteria were used to assessed clinical effects after operation.Results: All patients completed surgery and were followed up for more than 1 year. (1)There were no significant differences in the intraoperative blood loss or hospitalization length between two groups(P>0.05). The operation length and intraoperative fluoroscopy times in PETD group were significantly higher than in PEID group(P<0.05). (2)VAS,JOA scores,ODI at 1 week,6 months,or 12 months after operation were significantly improved between two groups(P<0.05),but there was no statistical significance between two groups(P>0.05). (3)The excellence rate was 89.87% (71/79) in PETD group and 87.34% (69/79) in PEID group at the latest follow-up,with no statistical significance(P>0.05). (4)Complications occurred in 2 cases in PETD group and in 3 cases in PEID group,with no significant differences between two groups.Conclusion: The short-term efficacy of the PETD is equal to that of the PEID for the L₅S₁ disc herniation,but PEID is superior in the operation length,the access of stereotaxic puncture and intraoperative fluoroscopy times. The complications can be effectively reduced by following the indications,mastering the endoscopic technique,operating carefully and being familiar with the key points of common complications.