椎板间入路经皮内镜椎间盘摘除术治疗L5~S1腋下型腰椎间盘突出症效果分析

目的探讨椎板间入路皮内镜经椎间盘摘除术(PEID)治疗L₅~S₁腋下型腰椎间盘突出症(LDH)的临床效果。方法回顾性分析2014-07—2020-06中国人民解放军联勤保障部队第九九〇医院信阳医疗区骨科收治的72例L₅~S₁腋下型LDH患者的临床资料。分为椎板间入路PEID组(PEID组,31例)和传统后路开放椎间盘摘除术组(传统开放组,41例)。比较2组患者的手术情况、术后临床指标及各时间点的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)。结果PEID组的切口长度、手术时间、术中出血量,以及术后卧床时间和拆线时间均短(少)于传统开放组,差异有统计学意义(P<0.05)。术后随访9~12个月,2组患者各时间点的VAS、ODI评分均优于术前,差异有统计学意义(P<0.05)。除PEID组患者术后第3天的VAS评分优于传统开放组,差异有统计学意义(P<0.05)外,其他时间点2组患者的VAS、ODI评分,以及并发症发生率差异均无统计学意义(P>0.05)。结论椎板间入路PEID与传统后路开放椎间盘摘除术治疗L₅~S₁腋下型LDH,在改善患者的VAS、ODI评分方面差异均无统计学意义,但椎板间入路PEID具有切口小、手术时间短、术中出血量少、术后早期痛苦小,以及并发症发生率不高等优势,故更有利于患者术后恢复。

Effect analysis of percutaneous endoscopic interlaminar discectomy in treatment of axillary herniation of L_5-S_1 disc

Objective To explore the clinical effects of percutaneous endoscopic interlaminar discectomy(PEID)in treatment of the axillary herniation(LDH)of the L₅~S₁ disc.Methods The data of 72 cases with axillary herniation of the L₅~S₁ disc from July 2014 to June 2020 in our department were retrospectively analyzed.The cases were divided into the group treated with PEID(31 cases)and the group treated with traditional open discectomy with posterior access(41 cases).The operation data,postoperative clinical index,the pain scores of visual analog scale(VAS)and Oswestry disability indexes(ODI)of each time node were compared between the two groups.Results The length of operative incision,the operation duration,the volume of blood loss,the postoperative bed rest duration and the suture removal time of the group with PEID was shorter than that of the group with traditional open discectomy,the difference was statistically significant(P<0.05).After a postoperative follow-up of 9 to 12 months,in each group,the VAS and ODI scores at each postoperative time nodes were better than those at preoperative time,the difference was statistically significant(P<0.05).The difference of the VAS score,ODI score at each time node and the incidence of complications between the two groups was no statistically significant(P>0.05),except that the VAS score at the 3th day after operation of the group with PEID was better than that of the group with traditional open discectomy,which was statistically significant(P<0.05).Conclusion The difference was no statistically significant in improving the score of VAS or ODI in treatment of the axillary herniation of the L₅~S₁ disc with PEID and with traditional open discectomy.However,the treatment of the axillary herniation of the L₅~S₁disc with PEID has shorter incision,shorter operation duration,less intraoperative blood loss,less early postoperative pain,less complications and so on advantage.So it is more conducive to the patients'postoperative recovery.