经皮椎板间隙入路全脊柱内镜微创治疗L5-S1椎间盘突出症的临床价值

目的 探讨经皮全脊柱内镜下椎板间入路椎间盘切除术(percutaneous endoscopic interlaminar discectomy,PEID)微创治疗L5-S1椎间盘突出症(prolapse of lumbar intervertebral,PLID)的临床价值.方法 回顾性分析2013年5月至2016年5月在我院进行手术治疗的76例PLID患者临床资料,按照数字表法随机分为观察组和对照组,每组38例.观察组行PEID治疗,对照组行传统开放手术治疗,分别对2组患者治疗前后下肢VAS评分、ODI评分、腰椎JOA评分及手术效果进行比较.结果 观察组患者手术时间明显短于对照组,术中出血量明显少于对照组,差异有统计学意义(P<0.05),术后住院时间短于对照组.与术前比较,2组患者术后3、6、24个月腰痛VAS、ODI评分均降低,而JOA评分均增高,差异有统计学意义(P<0.01),但2组间对应的时间点评分比较差异则均无统计学意义(P>0.05).结论 PEID与开放手术治疗L5-S1 PLID具有较好的临床效果,但经皮脊柱内镜技术对机体创伤小,有利于术后恢复,具有很好的临床应用价值.

Clinical value of percutaneous endoscopic interlaminar discectomy in the treatment of lumbar disc herniation

Objective To evaluate the clinical value of percutaneous endoscopic interlaminar discectomy in the treatment of L5-S1 prolapse of lumbar intervertebral discectomy ( PLID) .Methods Retrospective analysis was made in the medical data of 76 pa-tients with PLID who underwent surgical treatment in our hospital from May 2013 to May 2016.The patients were randomly divided into the observation group and the control group , each consisting of 38 patients.The observation group received PEID , while the control group was given traditional open surgery .Then, scores of visual analogue scale ( VAS) , ODI and lumbar disc JOA were evaluated and surgical efficacy were compared between the 2 groups.Results Surgical time of the observation group was obviously shorter than that of the control group , blood loss of the observation group was significantly less than that of the control group , and the duration of stay in the hospital was also shorter than that of the control group (P<0.05).As compared with those before surgery, the scores of VAS and ODI at the time points of 3, 6 and 24 months after surgery were all decreased for the patients of the 2 groups, while the JOA scores were all increased (P<0.01).However, no statistical significance could be seen, when comparisons were made between the 2 groups(P>0.05).Conclusion PEID could produce almost the same identical clinical effects as those of open surgery in the treatment of L 5-S1 PLID, nevertheless , percutaneous endoscopic interlaminar discectomy had the advantages of less trauma and faster recovery after surger -y.For this reason, it promised good clinical application .