【摘要】 目的 比较经皮椎间孔镜下椎间盘切除术（PTED）治疗上腰椎椎间盘突出症（ULDH）与下腰椎椎间盘突出症（LLDH）的临床疗效，比较PTED在不同节段腰椎间盘突出症（LDH）治疗中的有效性和安全性差异。方法 回顾性分析2020年1月至2024年1月接受PTED手术的84例（LDH）患者的临床资料，术前均行影像学检查确诊为ULDH(L_1-2、L_2-3)或LLDH(L_4-5),ULDH组42例，按性别和年龄1∶1匹配LLDH组42例。两组均行PTED手术，术后随访1年，采用视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）及MacNab标准评估疗效。结果 两组手术时间和术后住院时间差异无统计学意义（P > 0.05）。ULDH组术后短暂感觉异常2例、LLDH组1例，均未发生严重并发症，两组并发症发生率差异无统计学意义（P > 0.05）。两组患者术后1 d与术后1年腰痛VAS评分、腿痛VAS评分以及术后1年ODI均较同组术前显著改善（均P<0.05），且术后1年腰痛VAS评分、腿痛VAS评分较同组术后1 d显著改善（均P<0.05）；但三项指标在手术前后的组间差异均无统计学意义（均P > 0.05）。ULDH组优良率为88.10%,LLDH组为92.86%，两组间无显著差异（P=0.713）。结论 PTED治疗ULDH与LLDH的短期疗效和安全性相当，术后疼痛缓解、功能恢复及并发症发生率均无显著差异。更多还原

【Abstract】 Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy（PTED） in treating upper lumbar disc herniation（ULDH） and lower lumbar disc herniation（LLDH）, and to validate the differences in effectiveness and safety of PTED for lumbar disc herniation（LDH） at different spinal levels. Methods Clinical data of 84 patients who underwent PTED between January 2020 and January 2024 were retrospectively analyzed. All patients were preoperatively diagnosed with ULDH(L_1-2, L_2-3) or LLDH(L_4-5) via imaging. Of them, 42 ULDH patients were involved into ULDH group, and then 42 patients in LLDH group were matched 1:1 by gender and age. Patients were followed up for 1 year postoperatively.Outcomes were evaluated using visual analogue scale（VAS）, Oswestry disability index（ODI） and MacNab criteria. Results No statistical differences were found in operative time or postoperative hospital stay between two groups（P >0.05）. Transient postoperative sensory abnormalities occurred in two patients in ULDH group and one patient in LLDH group, with no severe complications reported. There was no statistical difference of complication incidence between two groups（P >0.05）. In both groups, there were significant improvements in VAS scores for low back pain and leg pain at 1 day and 1 year postoperatively, as well as in ODI at 1 year postoperatively, compared to the preoperative levels（all P <0.05）. Furthermore, VAS scores for low back pain and leg pain at 1 year postoperatively showed significant improvement compared to those at 1 day postoperatively（all P <0.05）. However, there were no statistical differences between the two groups in these three outcome indicators before and after the surgery（all P >0.05）. The excellent-good rate was 88.10% in ULDH group and 92.86% in LLDH group, with no significant difference between the groups（P = 0.713）. Conclusion PTED has been demonstrated to obtain comparable short-term efficacy and safety in the treatment of ULDH and LLDH, with no significant differences in pain relief, functional recovery, or complication rates.更多还原