经椎间孔入路经皮内窥镜下椎间盘切除术治疗旁中央型腰椎椎间盘突出症

目的比较BEIS(broad easy immediate surgery)技术经椎间孔入路经皮内窥镜下椎间盘切除术(PETD)和传统椎板间开窗椎间盘切除术治疗旁中央型腰椎椎间盘突出症(LDH)的临床效果。方法 2015年1月—2017年1月,亳州市人民医院收治中央型LDH患者78例,接受BEIS技术PETD治疗40例(A组),接受椎板间开窗椎间盘切除术治疗38例(B组)。比较2组的切口长度、出血量、手术时间、日本骨科学会(JOA)评分、疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、住院时间、并发症及复发率。结果所有手术均顺利完成,患者随访1222个月。2组手术时间差异无统计学意义(P 0.05);A组在切口长度、出血量及住院时间上均优于B组,差异均有统计学意义(P 0.05)。2组患者术后ODI、VAS评分及JOA评分与术前相比均明显改善,差异均有统计学意义(P 0.05)。2组JOA评分改善率差异无统计学意义(P 0.05)。2组各有3例出现并发症,各有1例于术后随访时复发。结论 2种术式治疗旁中央型LDH效果相当,与传统的椎板开窗椎间盘切除术相比,BEIS技术行PETD具有手术切口小、出血量少、住院时间短等优点,值得临床推广应用。

Percutaneous endoscopic transforaminal discectomy for paracentral lumbar disc herniation

Objective To compare the clinical effects of percutaneous endoscopic transforaminal discectomy (PETD) using BEIS(broad easy immediate surgery) technique and traditional interlaminar fenestration discectomy for paracentral lumbar disc herniation(LDH). Methods From January 2015 to January 2017, 78 patients with paracentral LDH were included in the study, including 40 patients(group A) who underwent PETD using BEIS technique and 38 patients(group B) who underwent traditional interlaminar fenestration discectomy. The incision length, blood loss, operation time, Japanese Orthopedic Association(JOA) scores, visual analogue scale(VAS) scores, Oswestry disability index(ODI), hospital stay, complications and recurrence rate were compared between the 2 groups. Results All the operations were successfully completed. The patients were followed up for 12-22 months. There was no significant difference in operation time between the 2 groups (P>0.05); group A was superior to group B in incision length, blood loss and hospital stay, with a significant difference (P<0.05). The ODI, VAS and JOA scores of the 2 groups after the operation were significantly improved compared with those before the operation, all with significant differences (P<0.05). There was no significant difference in the improvement rate of JOA score between the 2 groups (P>0.05). Complications occurred in 3 patients in each group, and recurrence seen in 1 case in each group during follow-up. Conclusion Compared with traditional fenestration discectomy, PETD using BEIS technique has the advantages of small incision, less blood loss and shorter hospital stay, thus being worthy of wider clinical application.