经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究

发布时间：2018-06-12 12:45

本文选题：经皮椎间孔镜椎间盘切除术 + 椎板开窗椎间盘切除术　；参考：《中国微创外科杂志》2017年06期

【摘要】：目的探讨经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)与椎板开窗椎间盘切除术(fenestration discectomy,FD)治疗腰椎间盘突出症患者的效果。方法选择我院2014年3月~2016年2月90例单节段单侧腰椎间盘突出症,按随机数字表随机分为FD组和PTED组,每组45例。FD组采用椎板开窗髓核摘除术,即硬膜外麻醉,单侧椎板开窗减压、髓核摘除以及神经根减压松解。PTED组实施经皮椎间孔镜技术,即在局麻内镜下切除突出的椎间盘髓核组织,并进行神经根的减压和松解。比较2组手术时间、切口长度、术后住院时间、视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)以及末次随访时疗效情况。结果 2组患者均顺利完成手术。PTED组手术时间(82.8±34.3)min,与FD组(75.4±35.6)min无统计学差异(t=1.004,P=0.318);2组切口长度[(0.5±0.2)cm vs.(3.1±0.3)cm,t=-48.374,P=0.000]、住院时间[(7.8±2.3)d vs.(10.1±3.3)d,t=-3.836,P=0.000]差异均有统计学意义。90例随访6~20个月,平均13个月,无一例腰椎间盘突出复发。与术前比较,术后2组VAS、ODI评分显著降低(P0.05),但2组间比较差异无统计学意义(P0.05)。PTED组优良率为93.3%(42/45),FD组优良率88.9%(40/45),2组比较差异无统计学意义(Z=-0.566,P=0.571)。结论 FD和PTED治疗腰椎间盘突出症疗效无差异,但PTED手术切口小、术后住院时间短、恢复快。
[Abstract]:Objective to investigate the effect of percutaneous transforaminal discectomy (transforaminal endoscopic) and fenestration discectomyd (FDD) in the treatment of lumbar disc herniation. Methods from March 2014 to February 2016, 90 patients with unilateral lumbar disc herniation in our hospital were randomly divided into FD group and PTED group. 45 cases of FD group were treated with fenestration of lamina pulposus, or epidural anesthesia. Unilateral lamina fenestration, nucleus pulposus excision and nerve root decompression. PTED group were treated with percutaneous foramen endoscopy, in which the protruding nucleus pulposus tissue was removed under local anesthesia, and the nerve root was decompressed and released. The operation time, incision length, postoperative hospitalization time, visual analogue scale index (Oswestry disability index) and the curative effect at the last follow-up were compared between the two groups. Results the operation time was 82.8 卤34.3 min in the two groups, and there was no significant difference between the FD group and the FD group (75.4 卤35.6)min). There was no significant difference in the length of incision between the two groups (0.5 卤0.2)cm vs.(3.1 卤0.3 0.2)cm vs.(3.1 卤0.38.374P0.000), and the length of hospitalization [7.8 卤2.3d vs.(10.1 卤3.836P0. 000] was statistically significant. 90 cases were followed up for 620 months, with an average of 13 months. No recurrence of lumbar disc herniation occurred. Compared with pre-operation, the scores of VAS-ODI in the two groups were significantly lower than those before operation, but there was no significant difference between the two groups. The excellent and good rate of the two groups was 93.3g / 42.45% FD group. There was no significant difference in the excellent and good rate between the two groups. Conclusion there is no difference between FD and PTED in the treatment of lumbar disc herniation.
【作者单位】：常州市第二人民医院骨科;
【分类号】：R687.3

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