Song Hongyu, Hu Wenhao, Liu Zhongguo, Hao Yongyu, Zhang Xuesong
Department of Orthopaedics, General Hospital of People's Liberation Army, Beijing, People's Republic of China.
Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, People's Republic of China.
J Orthop Surg Res. 2017 Oct 30;12(1):162. doi: 10.1186/s13018-017-0662-4.
Percutaneous endoscopic laminar discectomy is a typical minimally invasive discectomy operation that is classified into the percutaneous endoscopic transforaminal discectomy and the percutaneous endoscopic interlaminar discectomy. Based on whether the surgeon chooses to deal with the ligamentum flavum under endoscope guidance, percutaneous endoscopic discectomy by the interlaminar approach can be performed with a full endoscope technique with the intermittent endoscope technique. To our knowledge, there is no study comparing these two techniques in regard to their surgical effects and advantages. Therefore, we conducted this study to compare the cost, safety, and efficacy between the intermittent endoscopy technique and full endoscopy technique of endoscopic interlaminar lumbar discectomy at the L5-S1 level.
From September 2014 to March 2015, a total of 126 patients with radiculopathy due to L5-S1 disc herniation who were treated by a full endoscopy technique (65 patients) or intermittent endoscopy technique (61 patients) were included. Relevant data, such as duration time of the operation, hospitalization expenses, postoperative bed rest time, length of hospitalization, and complication rates, were recorded. Clinical outcomes were assessed by the visual analog scale score, modified MacNab criteria, and Oswestry disability index.
In the full endoscope (FE) group, the mean duration time of surgery was 75.0 ± 11.9 min. The postoperative bed rest time was 6.5 ± 1.1 h, length of hospitalization was 3.8 ± 1.1 days, and complication rate was 7.69%. In the intermittent endoscopy (IE) group, the mean duration time of surgery was 43.0 ± 16.4 min. The postoperative bed rest time was 5.0 ± 1.1 h, length of hospitalization was 3.6 ± 1.2 days, and complication rate was 6.60%. The average hospitalization expenses of the FE group and IE group, respectively, were 32,069 ± 1086 RMB and 22,665 ± 899 RMB. There were significant differences in the surgical duration and hospitalization expenses (P < 0.01), but no differences between the two groups in postoperative bed rest time, length of hospitalization, or complication rates (P > 0.05). The postoperative Oswestry disability index and VAS were clearly improved in both groups compared with those of preoperation (P < 0.01). These two procedures have the same clinical outcomes (P > 0.05).
Both the full endoscopy technique and intermittent endoscopy technique achieved good outcomes, whereas the intermittent endoscopy technique is a more effective option for a shorter duration surgery and lower hospitalization expenses.
经皮内镜下椎板间椎间盘切除术是一种典型的微创椎间盘切除术，分为经皮内镜下经椎间孔椎间盘切除术和经皮内镜下椎板间椎间盘切除术。根据外科医生是否选择在内镜引导下处理黄韧带，经皮内镜下椎板间入路椎间盘切除术可采用全内镜技术或间歇内镜技术进行。据我们所知，尚无研究比较这两种技术的手术效果和优势。因此，我们进行了这项研究，以比较L5-S1节段内镜下椎板间腰椎间盘切除术的间歇内镜技术和全内镜技术在成本、安全性和疗效方面的差异。
2014年9月至2015年3月，共纳入126例因L5-S1椎间盘突出症导致神经根病并接受全内镜技术治疗（65例）或间歇内镜技术治疗（61例）的患者。记录相关数据，如手术持续时间、住院费用、术后卧床时间、住院时间和并发症发生率。通过视觉模拟评分、改良MacNab标准和Oswestry功能障碍指数评估临床疗效。
全内镜（FE）组手术平均持续时间为75.0±11.9分钟。术后卧床时间为6.5±1.1小时，住院时间为3.8±1.1天，并发症发生率为7.69%。间歇内镜（IE）组手术平均持续时间为43.0±16.4分钟。术后卧床时间为5.0±1.1小时，住院时间为3.6±1.2天，并发症发生率为6.60%。FE组和IE组的平均住院费用分别为32069±1086元和22665±899元。手术持续时间和住院费用存在显著差异（P<0.01），但两组在术后卧床时间、住院时间或并发症发生率方面无差异（P>0.05）。与术前相比，两组术后Oswestry功能障碍指数和视觉模拟评分均明显改善（P<0.01）。这两种手术的临床疗效相同（P>0.05）。
全内镜技术和间歇内镜技术均取得了良好的效果，而间歇内镜技术对于缩短手术时间和降低住院费用是一种更有效的选择。
