两种不同入路经皮椎间孔镜技术治疗高位腰椎间盘突出症

目的:探讨不同入路的两种经皮穿刺椎间孔镜技术治疗高位腰椎间盘突出症的临床疗效。方法:回顾性分析2015年3月至2019年8月,采用经皮内镜腰椎间盘切除术(percutaneous endoscopic lumbar dicecromy,PELD)治疗的32例高位腰椎间盘突出症患者,根据手术入路不同分为经皮内镜椎间孔入路椎间盘切除术(percutaneous endoscopic transforaminal discectomy,PETD)和经皮内镜椎板间入路椎间盘切除术(percutaneous endoscopic interlaminar discectomy,PEID)。PETD组19例,男10例,女9例;年龄30～65(44.70±12.08)岁;L_(1,2)节段5例,L_(2,3)节段6例,L_(3,4)节段8例;中央型突出6例,旁中央型突出8例,突出移位5例。PEID组13例,男4例,女9例;年龄25～55(42.23±12.09)岁;L_(1,2)节段3例,L_(2,3)节段4例,L_(3,4)节段6例;中央型2例,旁中央型4例,突出移位3例,脱垂游离型4例。比较两组患者术前、术后第3天,术后3和6个月时VAS、ODI,并于术后1年采用改良MacNab标准评估临床疗效。结果:32例患者均顺利完成手术治疗。PETD组随访12～24(15.80±3.48)个月,PEID组随访12～30(16.70±4.66)个月,但两组随访时间比较差异无统计学意义(P0.05)。无神经损伤及椎间隙感染的病例。PETD组中1例患者术中出现硬膜囊撕裂,术后无不良反应。两组患者术后各时间点腰痛和腿痛VAS评分、ODI均较术前明显改善(P0.05)。术后1年根据改良Macnab标准,PETD组优11例,良6例,可1例,差1例;PEID组优7例,良4例,可2例。结论:经两种入路椎间孔镜技术治疗高位腰椎间盘突出症均能取得满意疗效,PETD技术更适合于中央型、旁中央型及轻度移位的患者,PEID技术对于脱垂游离型有优势。

Treatment of upper lumbar disc herniation with percutaneous endoscopic lumbar discectomy through two different approaches

Objective: To explore clinical efficacy of percutaneous endoscopic lumbar discectomy through two different approaches in treating upper lumbar disc herniation.Methods: From March 2015 to August 2019,32 patients with upper lumbar disc herniation treated by percutaneous endoscopic lumbar dicecromy(PELD) were analyzed retrospectively and divided into percutaneous endoscopic transforaminal discectomy(PETD) and percutaneous endoscopic interlaminar discectomy (PEID) group according to different methods. There were 19 patients in PETD group,including 10 males and 9 females aged from 30 to 65 years old with an average of(44.70±12.08) years old;5 patients on L_1,2,6 patients on L_2,3,8 patients on L_3,4;6 patients were central herniation,8 patients were paracentric herniation,and 5 patients were migration of herniation. There were 13 patients in PEID group,including 4 males and 9 females aged from 25 to 55 years old with an average of(42.23±12.09) years old;the courses of disease ranged from 1 to 7 months with an average of (2.90±3.02) months;3 patients on L_1,2,4 patients on L_2,3,6 patients on L_3,4;2 patients were central herniation,4 patients were paracentric herniation,3 patients were migration of herniation,4 patients were prolapse free type protrusion. VAS and ODI score before operation,postoperative at 3 days,3 and 6 months were compared between two groups,advanced MacNab standard at 1 year after operation were applied to evaluate clinical effects.Results: Operation were successful operated in 32 patients and obtained following up without nerve injury and infection of intervertebral space. One patient in PETD groups occurred dural sac tear in operation,but no adverse reaction after operation. PETD group was followed up from 12 to 24 months with an average of (15.80±3.48) months,while PEID group was followed up from 12 to 30 months with an average of(16.70±4.66) months,while there was no statistical difference between two groups(P>0.05). VAS and ODI score at different time points after operation were higher than that of before operation (P<0.05). According to advanced MacNab standard at 1 year after operation,11 patients obtained excellent results,6 good,1 moderate and 1 poor in PETD group;while 7 patients got excellent results,4 good,2 moderate in PEID group.Conclusion: Both of two surgical approach could achieve satisfactory efficacy in treating upper lumbar disc herniation,PETD is more suitable for central herniation,paracentric herniation and patients with mild displacement,PEID has advantage on prolapse free type protrusion.