不同术式治疗腰椎椎间盘突出症的疗效对比

目的比较经皮内窥镜下腰椎椎间盘切除术(PELD)、后路显微内窥镜下椎间盘切除术(MED)及后路小切口椎间盘切除术(MD)治疗腰椎椎间盘突出症(LDH)的疗效。方法回顾性分析2016年8月—2018年10月在重庆医科大学附属永川医院接受手术治疗的96例LDH患者临床资料,按照手术方式分为PELD组、MED组和MD组,每组32例,记录并比较3组手术时间,切口长度,透视次数,术中出血量,术后卧床时间,住院时间,术后3 d血清肌酸磷酸激酶(CPK)水平,术后1 d、3 d切口疼痛程度,术前、术后1个月、术后12个月腰腿痛视觉模拟量表(VAS)评分及Oswestry功能障碍指数(ODI)。采用改良MacNab标准评估疗效,观察并发症发生情况。结果PELD组在切口长度、术后卧床时间、住院时间、术后3 d CPK水平及术后1 d、3 d伤口疼痛程度方面优于MED组,而MED组优于MD组;术中出血量PELD组0.05)。3组术后1个月、12个月腰痛及腿痛VAS评分、ODI较术前明显改善,差异均有统计学意义(P<0.05);组间比较,差异无统计学意义(P>0.05);术后所有病例腿痛缓解较腰痛缓解更为明显。末次随访时3组间疗效优良率比较,差异无统计学意义(P>0.05)。3组均无严重并发症发生,轻微并发症经术中、术后对症处理后改善。结论3种手术方式均为治疗LDH的有效方案,PELD最为微创,符合快速康复理念,对于外侧型及旁侧型LDH具有明显优势,而中央型LDH采用MED治疗为宜。

Efficacy comparison of different surgical methods for lumbar disc herniation

Objective To compare the efficacy of percutaneous endoscopic lumbar discectomy(PELD),posterior micro-endoscopic discectomy(MED) and posterior micro-discectomy(MD) in the treatment of lumbar disc herniation(LDH). Methods The clinical data of 96 patients with LDH in Yongchuan Hospital of Chongqing Medical University from August 2016 to October 2018 were analyzed retrospectively. According to the surgical method,patients were divided into PELD group,MED group and MD group,32 cases in each group. Operation time,incision length,fluoroscopy frequency,intraoperative blood loss,postoperative in bed time,hospital stay,serum creatine phosphokinase(CPK) level at postoperative 3 d,incision pain at postoperative 1 and 3 d,visual analogue scale(VAS) score and Oswestry disability index(ODI) at pre-operation,postoperative 1 month and 12 months were recorded and compared between the 3 groups. The modified MacNab criteral was used to evaluate the clinical efficacy,and the incidence of complications were observed. Results The incision length,postoperative in bed time,hospital stay,CPK level at postoperative 3 d and incision pain at postoperative 1 and 3 d in PELD group were superior to those in MED group,while MED group was superior to MD group;in intraoperative blood loss,PELD group < MED group < MD group;the pairwise differences of the above indicators were statistically significant between the 3 groups(P<0.05). The operation time of PELD group was longer than that of the other 2 groups,and the fluoroscopy frequency was significantly higher than that of the other 2 groups,all with a statistically significant difference(P<0.05). There was no significant difference in operation time and fluoroscopy frequency between MED group and MD group(P>0.05). The VAS score of low back pain and leg pain and ODI were significantly improved in the 3 groups at postoperative 1 month and 12 months,all with a statistical signifiance(P<0.05);the difference between the 3 groups was not statistically significant(P>0.05);the relief of leg pain was more obvious than the low back pain in all the cases. At the final follow-up,there was no significant difference in the excellent and good rate of efficacy between the 3 groups(P<0.05). No serious complications occurred in the 3 groups,and minor complications were improved after symptomatic treatment during and after the operation. Conclusions All the 3 surgical methods are effective for the treatment of LDH. PELD is the most minimally invasive,in line with the concept of rapid rehabilitation,thus having obvious advantages for the lateral and paracentral LDH,while the central LDH should be treated with MED.