经椎板间完全内镜下与椎间盘镜下L5/S1椎间盘切除术的中期临床疗效比较

A mid-term comparison between percutaneous endoscopic interlaminar discectomy and micro-endoscopic discectomy for L5/S1 lumbar disc herniation

中文关键词:  腰椎  椎间盘移位  外科手术  内镜  椎板切除

英文关键词:Lumar vertebrae  Intervertebral disc displacement  Surgical treatment  Endoscopy  Laminectomy

中文摘要:

  【摘要】 目的：比较经椎板间完全内镜辅助下椎间盘切除术（percutaneous endoscopic interlaminar discectomy, PEID）和椎间盘镜辅助下椎间盘切除术（micro-endoscopic discectomy，MED）在治疗特殊类型L5/S1椎间盘突出症的中期临床疗效。方法：采用前瞻性随机对照研究的方法，将2013年2月～2015年2月符合纳入标准的84例患者，随机分为PEID组和MED组，各42例。随访1年以上，记录两组患者的切口长度、手术时间、术中透视次数、术后住院天数、并发症发生率；手术疗效按照Oswestry功能障碍指数（Oswestry disability index，ODI）、疼痛视觉类比评分（visual analogue scale，VAS）和改良的Macnab标准评定。结果：所有病例均顺利完成手术。PEID组手术时间35～80min，平均54.4±10.6min；切口长度平均7mm；术后住院时间2～5d，平均3.4±0.6d；透视次数2~5次，平均2.4±0.5次；MED组手术时间45~90min，平均65.4±12.4min；切口长度平均18mm；术后住院时间3~8d，平均5.4±1.2d；透视次数2~5次，平均2.3±0.6次。PEID组手术时间、切口长度和住院天数均比MED组减少，差异有统计学意义（P<0.05）；透视次数PEID组与MED组比较，差异无统计学意义（P>0.05）。PEID组腰痛、腿痛VAS术前分别为2.4±1.0和6.4±1.3；术后1d为1.4±1.2和1.0±0.8；术后1个月时为1.6±1.4和1.2±0.6；术后1年时为2.0±1.6和1.8±1.4；术前、术后1年时的ODI别为（58.4±18.0）%和（18.4±10.0）%。MED组腰痛、腿痛VAS术前分别为2.6±1.2和7.0±1.0；术后1d为2.2±1.0和1.8±1.6；术后1个月时为2.0±1.3和1.6±1.1；术后1年时为2.2±1.5和2.1±1.2；术前、术后1年时ODI分别为（60.2±17.2）%和（20.0±14.2）%。两组患者术后各随访时间点腰痛、腿痛VAS评分较术前均有明显改善（P<0.05）；术后1d时两组间腰痛、腿痛VAS评分PEID组均低于MED组（P<0.05）；两组间术前、术后1年时腰痛、腿痛VAS评分和ODI比较差异均无统计学意义（P>0.05）；按照改良的MacNab法评定术后1年优良率分别为90.9%和92.7%，两组差异无显著性（P>0.05）。结论：PEID和MED两种微创术式治疗L5/S1腰椎间盘突出症的中期疗效均满意，PEID更具有微创优势，是一种值得推广的手术方法。

英文摘要:

  【Abstract】 Objectives: To compare mid-term clinical outcome between percutaneous endoscopic interlaminar discectomy(PEID) and micro-endoscopic discectomy(MED) for special type L5/S1 lumbar disc herniation. Methods: A total of 84 cases with special type L5/S1 lumbar disc herniation were included from February 2013 to February 2015. They were randomly divided into 2 groups, with 42 cases treated with PEID and 42 cases treated with MED. The data including the length of skin incision, the operation time, the exposure of intraoperative fluoroscopy, the postoperative hospital stay, the complication rate were recorded. The evaluation of clinical effectiveness was based on the Oswestry disability index(ODI), visual analogue scale (VAS), and modified MacNab criteria. Results: All the procedures were performed successfully. In PEID group: the operation time was 35-80min, averaging 54.4±10.6min; incision length was 7mm; hospitalization time was 2-5 days, averaging 3.4±0.6 days; C-arm time was 2-5 times, averaging 2.4±0.5 times. While in MED group: the operation time was 45-90min, averaging 65.4±12.4min; incision length was 18mm; the hospitalization time was 3-8 days, averaging 5.4±1.2 days; C-arm time was 2-5 times, averaging 2.3±0.6 times. The operation time, length of incision and the postoperative hospital stay in PEID group were less than those in MED group(P<0.05). There was no significant difference between the 2 groups on C-arm time(P>0.05). In PEID group, the preoperative low back pain and leg pain VAS score were 2.4±1.0 and 6.4±1.3 respectively; 1.4±1.2 and 1.0±0.8 at one day of postoperation; 1.6±1.4 and 1.2±0.6 at one month; 2.0±1.6 and 1.8±1.4 at 1 year; the preoperative and 1 year postoperative ODI were (58.4±18.0)% and (18.4±10.0)% respectively. In MED group, preoperative low back pain and leg pain VAS were 2.6±1.2 and 7.0±1.0 respectively; 2.2±1.0 and 1.8±1.6 at one day of postoperation; 2.0±1.3 and 1.6±1.1 at one month; 2.2±1.5 and 2.1±1.2 at 1 year; preoperative and one year postoperative ODI were (60.2±17.2)% and (20.0±14.2)% respectively. Postoperative VAS in both PEID group and MED group significantly improved compared with preoperative ones(P<0.05). In the first day after operation, VAS in PEID group was significantly lower than that in MED group(P<0.05). While between preoperation and one year after operation, there was no significant difference between PEID group and MED group with regard to VAS and ODI(P>0.05). One year after operation, according to the modified MacNab criteria, the excellent and good rate was 90.9% in PEID group and 92.7% in MED group, but there was no significant difference(P>0.05). Conclusions: It is certain that PEID and MED are effective minimally invasive surgical technique for special type L5/S1 lumbar disc herniation in Mid-term. PEID is superior than MED.