【摘要】 [目的]比较椎板开窗髓核摘除术(fenestration discectomy,FD)和经椎间孔镜髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症(lumbar intervertebral disc herniation,LDH)的临床疗效。[方法]2012年6月~2015年2月,将50例初次单节段LDH患者随机分为椎板开窗组(25例)和椎间孔镜组(25例)。两组年龄、性别、病变节段差异无统计学意义(P>0.05),椎板开窗组在全麻下行后路开窗髓核摘除术,椎间孔镜组在局麻下行经皮椎间孔镜髓核摘除术。比较两种术式的切口、手术时间、术中出血量、术后下地及住院时间,比较两组患者术前、术后的视觉疼痛模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会评分(Japanese Orthopaedic Association,JOA)。[结果]所有患者均获得随访,平均随访时间17.3个月(12~36个月)。椎板开窗组的手术时间少于椎间孔镜组(P<0.05),椎间孔镜组的切口长度、术中出血量、术后下地时间、住院时间少于椎板开窗组(P<0.05)。两组术后3、12个月ODI、VAS、JOA与术前比较,均明显改善(P<0.05),两组术后12个月的JOA评分改善率差异无统计学意义(P>0.05)。[结论]与椎板开窗组相比,椎间孔镜技术治疗LDH疗效确切,且具有创伤小、恢复快等优点,是治疗LDH更为理想的方法。更多还原

【Abstract】 [Objective] To compare the preliminary clinical outcomes of fenestration discectomy( FD) and percutaneous transforaminal endoscopic discectomy( PTED) for lumbar disc herniation( LDH) and summarize the clinical experience.[Methods] From June 2012 to Feb 2015,50 patients with primary single segment LDH were randomly divided into fenestration group and transforaminal endoscope group with 25 cases in each group. There were no significant differences in age,gender and segment of disease between the two groups( P > 0. 05). The patients of FD group were treated with intervertebral fenestration and removal of nucleus pulposus operation under general anesthesia by posterior approach,whereas the patients of PTED group underwent percutaneous transforaminal endoscope discectomy under local anesthesia. The factors including the length of skin incision,amount of operation time,intraoperative bleeding,ambulation and average hospitalization time were compared between the two groups. The visual analogue scale( VAS),Oswestry Disability Index( ODI) and Japanese Orthopedic Association( JOA) scores before and after operation were used to evaluate the clinical outcomes. [Results] All patients were followed up from 12 to 36 months with an average of 17. 3 months. The operation time in FD group were less than that in PTED group( P <0. 05). In contrary,the length of skin incision,intraoperative bleeding,ambulation and average hospitalization time in PTED group were less than those in FD group( P < 0. 05). The postoperative VAS,ODI and JOA scores at each follow- up time point in both groups were significantly improved compared with the preoperative data( P < 0. 05). There were no statistically significant differences between the 2 groups in the JOA score improvement rate( P > 0. 05). [Conclusion] Compared with open lumbar disectomy,PTED technique is a better method for LDH,with the advantages of less trauma and bleeding,rapid recovery.更多还原