| 椎间孔镜下经椎板间入路髓核摘除术与开窗髓核摘除术治疗L5/S1椎间盘突出的疗效分析 |
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投稿时间：2018-09-29 修订日期：2019-01-16
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| 期刊信息：《中国骨伤》年，第卷，第期，第-页 |
| DOI： |
| 基金项目:山东省自然科学基金(ZR2015YL034) |
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| 中文摘要:【】目的 探讨对比椎间孔镜下经椎板间入路髓核摘除术与开窗髓核摘除术治疗L5/S1椎间盘突出的临床疗效。方法：回顾性分析我科于2014.1月-2017.3月收治L5/S1椎间盘突出并获得随访患者86例,依据手术方法不同分成椎间孔镜组及开窗组。两组手术均在全身麻醉下进行,椎间孔镜组采用全脊柱内镜经椎板间入路髓核摘除术(Percuteneous endoscopic interlaminar discectomy,PEID),开窗组采用经典开窗髓核摘除术(Fenestration discectomy,FD)。记录比较两组患者切口长度,手术时间,出血量,住院时间,术后卧床时间,并发症,术前及术后患肢疼痛及腰部疼痛VAS评分,MACNAB评分,血清肌酸激酶,术后椎旁肌多裂肌残存率,评价治疗效果。结果：PEID组及FD组皮肤切口长度分别为0.7±0.1cm和5.0±1.8cm,出血量分别为8.0±3.0ml和62.0±50.5,住院时间分别为3.0±1.5天和11.0±2.5天,术后卧床时间分别为1.0±0.5天和3.0±0.8天,两组对比有显著性差异(P<0.05)。术后24小时及随访1年两组患肢疼痛VAS评分较术前均明显降低,但组间对比无统计学意义(P>0.05)。PEID及FD组术后24h腰痛VAS评分分别为2.99±0.32和5.44±1.31,随访1年,腰痛VAS评分分别为1.56±0.60和3.05±0.24两组有显著统计学意义(P<0.05)。术后24h、48小时FD组肌酸激酶指标较PEID组明显升高,统计学差异显著(P<0,05)。随访1年,两组Macnab优良率分别93%和95%,两组无显著性差异(P>0.05),通过MRI观察,PEID组术后1年椎旁多裂肌残存率明显高于开窗组(P<0.05)。两组患者均未发生硬脊膜撕裂、神经根损伤、血管损伤、椎间隙感染等并发症。结论：在治疗L5/S1椎间盘突出患者,两种方法均可取得满意效果,安全可靠,但在椎旁肌保护,手术切口,出血量,住院时间及术后卧床时间等指标上,椎间孔镜更具优势,更符合微创理念。 |
| 【关键词】腰椎间盘突出症 椎间盘摘除术 椎板间入路 开窗髓核摘除术 |
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| Comparision of surgical outcomes between percuteneous endoscopic interlaminar discectomy and fenestration discectomy for L5/S1 lumbar disc herniation |
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| ABSTRACT 【】Objective To evaluate the effectiveness of percuteneous endoscopic interlaminar discectomy (PEID)and fenestration discectomy(FD) for L5/S1 lumbar disc herniation. Methods A prospective clinical review was conducted on the two surgical methods for L5/S1 LDH from January 2014 to March 2017,one group of 43 patients who underwent PEID and the other of 43 patients who underwent FD. The operative incision,the operative time,intraoperative blood loss,duration of hospitalization,dose of analgesic agent used after surgery,pre- and postoperative assessment based on the criteria of visual analog scales (VAS),modified MacNab scores,CK(creatine kinase) pre- and postoperative and Survival rate of multifidus were recorded. For PEID and FD, the mean length of skin incision was 0.7±0.1cm and 5.0±1.8cm,the blood loss was 8.0±3.0ml and 62.0±50.5ml,hospitalization time was 3.0±1.5 days and 11.0±2.5 days,bed time after operation was1.0±0.5 days and 3.0±0.8days,There is a significant difference between the two groups(P<0.05). The VAS score after 24h-operation and 3-months follow-up in leg between the two groups showed no significant difference (P>0.05),but significantly lower than pre-operation. The VAS score of LBP in the PEID and FD groups was 2.99±0.32 and 5.44±1.31 in 24h after surgery, after 3-month follow up, the VAS score was and 1.56±0.60 and 3.05±0.24 respectively, which all has a significant difference(P<0.05). The CK in FD group increased significantly after surgery compared with that in PEID group (P<0.05) in 24h and 48h postoperation. After 3-month’ follow-up the total excellent to good ratio of modified MacNab score was 93.0% and 95% for PEID and FD respectively,all showed no significant difference (P>0.05).After 1-years follow-up,PEID have higher Survival rate of multifidus(P<0.05). Both of the two groups had no severe complications in two groups. Result： Conclusion：Both of the two methods are satisfactory and safety,PEID having more advantages in Paraspinal Muscle protection、operative incision and intraoperative blood loss.As a result,PEID is the ideal minimally invasive method instead of FD. |
| KEY WORDS Lumbar disc herniation Discectomy PEID Fenestration discectomy |
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