Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
World Neurosurg. 2019 May;125:e508-e514. doi: 10.1016/j.wneu.2019.01.114. Epub 2019 Jan 31.
To evaluate the results of percutaneous endoscopic transforaminal diskectomy (PETD) in comparison with percutaneous endoscopic interlaminar diskectomy (PEID) for axillar herniation at L5-S1.
From January 2017 to March 2018, 80 patients admitted with axillar herniation at L5-S1 were randomly recruited into 2 groups: 40 cases in the PETD group and 40 in the PEID group. Each group separately underwent PETD or PEID. Patient sex, age, body mass index, axillar herniation size, number of C-arm fluoroscopies, operation time, postoperative bed time, complications, and clinical effect were compared. Both groups were followed-up using the Oswestry Disability Index (ODI), visual analog scale (VAS), and Macnab criteria.
Except for 1 case in the PETD group that switched to the PEID group, the patients completed the study as expected. All patients were followed-up. Preoperative demographics were not significantly different (P > 0.05) between the 2 groups. The mean number of C-arm fluoroscopies (12.44 ± 3.21) and the operation time (66.49 ± 16.29 minutes) of the PETD group were significantly improved compared with the PEID group (number of fluoroscopies: 3.41 ± 0.81, P < 0.001; operation time: 53.56 ± 10.82 minutes, P < 0.001), but the postoperative bed rest time and complication rate were not (P > 0.05). The postoperative ODI and VAS scores were obviously improved in both groups when compared with preoperation (P < 0.001). There were no significant differences between the 2 groups in the Macnab criteria or VAS and ODI scores at the same time point (P > 0.05).
For axillar herniation at L5-S1, PEID can ignore the anatomic obstruction with advantages including a shorter operation time and less intraoperative radiation exposure. PETD has a clinical effect similar to that of PEID, but the process of it is more dangerous and harder than PEID.
评估经皮内镜椎间孔入路椎间盘切除术（PETD）与经皮内镜经椎间孔入路椎间盘切除术（PEID）治疗 L5-S1 腋窝疝的结果。
2017 年 1 月至 2018 年 3 月，80 例腋窝疝 L5-S1 患者被随机分为 2 组：40 例 PETD 组和 40 例 PEID 组。每组分别行 PETD 或 PEID。比较患者性别、年龄、体重指数、腋窝疝大小、C 臂透视次数、手术时间、术后卧床时间、并发症及临床效果。两组均采用 Oswestry 功能障碍指数（ODI）、视觉模拟评分（VAS）和 Macnab 标准进行随访。
除 1 例 PETD 组患者转为 PEID 组外，其余患者均按预期完成研究。所有患者均获得随访。两组术前一般资料比较差异无统计学意义（P > 0.05）。PETD 组平均 C 臂透视次数（12.44 ± 3.21）和手术时间（66.49 ± 16.29 分钟）明显优于 PEID 组（透视次数：3.41 ± 0.81，P < 0.001；手术时间：53.56 ± 10.82 分钟，P < 0.001），但术后卧床时间和并发症发生率差异无统计学意义（P > 0.05）。两组术后 ODI 和 VAS 评分均明显优于术前（P < 0.001）。两组 Macnab 标准及同一时间点 VAS 和 ODI 评分差异均无统计学意义（P > 0.05）。
对于 L5-S1 腋窝疝，PEID 可以忽略解剖学梗阻，具有手术时间短、术中辐射暴露少的优点。PETD 与 PEID 的临床效果相似，但过程比 PEID 更危险、更困难。
