经椎间孔入路与经椎板间入路经皮内镜椎间盘摘除手术治疗L5/S1腰椎间盘突出症的临床回顾性研究

目的探讨经皮内镜椎间盘摘除手术经椎间孔入路与经椎板间入路治疗L₅/S₁腰椎间盘突出症的临床疗效。方法43例L₅/S₁腰椎间盘突出症病人根据手术入路不同分为椎间孔入路组（21例）和椎板间入路组（22例）。按照术后疼痛视觉模拟（VAS）评分和改良MacNab评分判断临床效果，比较2组手术时间、术后卧床时间、术后住院时间、总住院费用、术后并发症情况。结果43例病人全部顺利完成手术，术后随访6个月以上。椎间孔入路组术后卧床时间、术后住院时间、总住院费用均低于椎板间入路组（P < 0.01）。2组病人术后1、3、6个月腰背部、腿部VAS评分均低于术前（P < 0.05），2组手术时间以及术前、术后各随访时间点腰背部、腿部VAS评分组间差异均无统计学意义（P>0.05）。改良MacNab评分椎间孔入路组优14例，良4例，可3例，差0例，椎板间入路组优13例、良5例、可4例、差0例，组间比较差异无统计学意义（P>0.05）。2组病人术后均未见严重并发症发生。结论经椎间孔入路与经椎板间入路经皮内镜下治疗L₅/S₁椎间盘突出症都具有安全、有效的特点；但相比之下，椎间孔入路创伤更小、恢复更快、手术禁忌更少，更加符合微创的理念。

Comparison study between intervertebral foramen approach and interlaminar approach percutaneous endoscopic lumbar discectomy in the treatment of L5/S1 disc herniation

ObjectiveTo investigate the clinical effects between intervertebral foramen approach and interlaminar approach percutaneous endoscopic lumbar discectomy in the treatment of L₅/S₁ disc herniation.MethodsForty-three patients with L₅/S₁ disc herniation were divided into the intervertebral foramen approach group (n=21) and interlaminar approach group (n=22).The clinical efficacy was assessed using Visual Analog Scale (VAS) and modified MacNab evaluation criteria.The operation time, postoperative ambulation time, postoperative hospitalization time, in-patient cost and postoperative complication were compared between two groups.ResultsAll opereations were successful.The patients were followed up for mone than 6 months.The bed time, postoperative hospitalization time, total hospitalization expense in intervertebral foramen approach group were lower than those in interlaminar approach group (P < 0.01).The VAS scores of back and leg in two groups after 1 month, 3 months and 6 months of operation were significantly lower than those before operation (P < 0.05).The differences of the operation time and VAS scores of back and leg in two groups between before and after operation were not statistically significant (P>0.05).The excellent in 14 cases, good in 4 cases, fair in 3 cases and poor in 0 case in intervertebral foramen approach group, and excellent in 13 cases, good in 5 cases, fair in 4 cases and poor in 0 case in interlaminar approach group were identified using improved MacNab scale, respectively, and the difference of which between two groups was not statistically significant (P>0.05).No severe complication in two groups was found after operation.ConclusionsThe intervertebral foramen approach and interlaminar approach percutaneous endoscopic lumbar discectomy in the treatment of L₅/S₁ disc herniation are safe and effective.Compared with the interlaminar approach, the intervertebral foramen approach has little invasion, quick recovery and few contraindications, which is more suitable to the concept of minimally invasive surgery.