经髂骨钻孔入路椎间孔镜手术与传统后入路椎板开窗髓核摘除术治疗高髂嵴L5/S1椎间盘突出症的短期疗效比较

目的对比经髂骨钻孔入路椎间孔镜手术与传统后入路椎板开窗髓核摘除术治疗高髂嵴L5/S1椎间盘突出症的短期临床疗效。方法选择72例由X线测量符合高髂嵴特征并经手术治疗的L5/S1椎间盘突出症患者,随机分为观察组和对照组,各36例。其中观察组采用经髂骨钻孔入路椎间孔镜手术治疗,对照组采用传统后入路椎板开窗髓核摘除术治疗。对比两组患者的围术期参数,包括手术时间、透视次数、术中出血量、术后1周和术后1个月的VAS评分及Oswestry功能障碍指数(ODI)以及并发症情况和满意度。结果观察组手术时间长于对照组,术中透视次数多于对照组,术中出血量少于对照组(均P<0.05)。术后1周和术后1个月,两组患者的VAS评分及ODI均较术前降低(均P<0.05),但两组患者的VAS评分、ODI、并发症及满意度比较,差异无统计学意义(均P>0.05)。结论对于高髂嵴的L5/S1椎间盘突出症患者,采取经髂骨钻孔入路椎间孔镜手术,可以较好地实现椎间盘减压及神经根松解,短期内的临床疗效和传统椎板开窗髓核摘除术相当,其术中出血量更少,是一种理想的入路选择。

Short-term efficacy of intervertebral foraminal endoscopic surgery via transiliac drilling approach versus lamina fenestration discectomy via traditional posterior approach for L5/S1 disc herniation with high iliac crest:a comparative study

Objective To compare the short-term clinical efficacy of intervertebral foraminal endoscopic surgery via transiliac drilling approach versus lamina fenestration discectomy via traditional posterior approach for L5/S1 disc herniation with high iliac crest.Methods Seventy-two patients,conformed to the characteristics of high iliac crest by X-ray measurement,who underwent surgery for L5/S1 disc herniation were randomly assigned to observation group or control group,with 36 cases in each group.Among them,the observation group was treated with intervertebral foraminal endoscopic surgery via transiliac drilling approach,while the control group was treated with lamina fenestration discectomy via traditional posterior approach.The perioperative parameters,including operation time,fluoroscopy times,intraoperative blood loss,the VAS scores and the Oswestry disability index(ODI)one week and one month after surgery,as well as complications and satisfaction were compared between the two groups.Results Compared to the control group,the observation group obtained longer operation time,more intraoperative fluoroscopy times,and less intraoperative blood loss(all P<0.05).The VAS scores and ODI one week and one month after surgery decreased in both groups compared to those before surgery(all P<0.05),but there were no statistically significant differences in VAS scores,ODI,complications or satisfaction between the two groups(all P>0.05).Conclusion For patients suffering from L5/S1 disc herniation with high iliac crest,intervertebral foraminal endoscopic surgery via transiliac drilling approach is an ideal approach,which can better decompress intervertebral disc and release nerve root,achieve a similar short-term clinical efficacy to lamina fenestration discectomy via traditional posterior approach,and with less intraoperative blood loss.