Nie Hongfei, Zeng Jiancheng, Song Yueming, Chen Guo, Wang Xiandi, Li Zhuhai, Jiang Hushan, Kong Qingquan
Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, China.
Spine (Phila Pa 1976). 2016 Oct;41 Suppl 19:B30-B37. doi: 10.1097/BRS.0000000000001810.
A prospective, randomized controlled study of patients with L5-S1 lumbar disc herniations, operated with endoscopic discectomy through an interlaminar or transforaminal approach.
To compare the results of percutaneous endoscopic lumbar discectomy in L5-S1 disc herniation through an interlaminar or transforaminal approach.
The transforaminal and interlaminar techniques are both acceptable approaches for L5-S1 disc herniation. This is the first study to compare these two approaches in terms of their surgical effects and advantages.
From January 2010 to June 2010, 60 patients with L5-S1 disc herniation were randomly recruited into two groups; one group underwent percutaneous endoscopic interlaminar discectomy (PEID) and the other group underwent percutaneous endoscopic transforaminal discectomy (PETD). There were 30 patients in each group. The operation time, intraoperative radiation time, postoperative bed rest time, hospitalization time, and complications were compared between the groups. The surgical effectiveness was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and modified MacNab criteria.
All the patients completed follow up with a mean of 27.6 months (range, 24-37 months). In the PEID group, the mean operation time was 65.0 ± 14.9 minutes, and the intraoperative radiation time was 0.60 ± 0.24 seconds. For the PETD group, the mean operation time was 86.0 ± 15.4 minutes, and the intraoperative radiation time was 6.50 ± 1.52 seconds. There were significant differences in operation time and radiation time between the two groups (P < 0.01) but not in the postoperative bed rest time, hospitalization time, or complication rate (P > 0.05). The postoperative ODI and VAS were obviously improved in both groups when compared with preoperation (P < 0.01). According to the MacNab criteria, the satisfactory rates were 93.3% and 90.0% in the two groups, without a significant difference (P > 0.05).
PEID can escape the blockade of crista iliaca, and advantages include a faster puncture orientation, a shorter operation time, and less intraoperative radiation exposure. PETD requires higher punctuation skill and more intraoperative radiation exposure.
一项针对 L5 - S1 腰椎间盘突出症患者的前瞻性随机对照研究，采用经椎板间或经椎间孔入路的内镜下椎间盘切除术。
比较经椎板间或经椎间孔入路行 L5 - S1 椎间盘突出症经皮内镜下腰椎间盘切除术的效果。
经椎间孔和经椎板间技术都是治疗 L5 - S1 椎间盘突出症可接受的方法。这是第一项比较这两种方法手术效果和优势的研究。
2010 年 1 月至 2010 年 6 月，60 例 L5 - S1 椎间盘突出症患者被随机分为两组；一组接受经皮内镜下椎板间椎间盘切除术（PEID），另一组接受经皮内镜下椎间孔椎间盘切除术（PETD）。每组 30 例患者。比较两组的手术时间、术中透视时间、术后卧床时间、住院时间及并发症。根据奥斯威斯功能障碍指数（ODI）、视觉模拟评分（VAS）和改良 MacNab 标准评估手术效果。
所有患者均完成随访，平均随访时间为 27.6 个月（范围 24 - 37 个月）。PEID 组平均手术时间为 65.0 ± 14.9 分钟，术中透视时间为 0.60 ± 0.24 秒。PETD 组平均手术时间为 86.0 ± 15.4 分钟，术中透视时间为 6.50 ± 1.52 秒。两组手术时间和透视时间差异有统计学意义（P < 0.01），但术后卧床时间、住院时间及并发症发生率差异无统计学意义（P > 0.05）。与术前相比，两组术后 ODI 和 VAS 均明显改善（P < 0.01）。根据 MacNab 标准，两组优良率分别为 93.3%和 90.0%，差异无统计学意义（P > 0.05）。
PEID 可避开髂嵴阻挡，具有穿刺定位快、手术时间短、术中透视暴露少等优点。PETD 需要更高的穿刺技巧且术中透视暴露多。
4 级。
