Lv Jianhua, Wang Xiang, Chen Meihua, Wu Jianfei
The Affiliated Hospital of Putian University, Department of Orthopaedics, Putian, Fujian, China.
Turk Neurosurg. 2020;30(3):387-393. doi: 10.5137/1019-5149.JTN.26972-19.2.
To compare the efficacy of percutaneous transforaminal endoscopic discectomy with and without epidural steroid application in the treatment of lumbar disc herniation.
A total of 101 patients who had indications for percutaneous transforaminal endoscopic discectomy were retrospectively reviewed. Patients were divided into two groups based on whether epidural steroids were applied following the surgical procedure. Each patient in group A received an epidural injection of 40mg triamcinolone acetonide through the working sleeve following the surgical procedure. However, patients in group B were not given the drug. Preoperative and postoperative radicular pain was measured with the visual analogue scale (VAS). Functional and satisfaction outcomes were measured with the Oswestry Disability Index (ODI) and the modified MacNab criteria, respectively.
A total of 97 patients had a complete follow-up of longer than two years without recurrence. The sample sizes of group A and group B were 56 and 41. The VAS scores and ODI scores at each postoperative follow-up point were significantly lower than the preoperative values (p < 0.001). However, there were no significant between-group differences (p > 0.05). The secondary outcomes of the changes in the VAS and ODI scores were also equivalent between the groups at the 3-month and 2-year follow-ups (p > 0.05). No significant difference was observed in the modified MacNab criteria between the groups at 2 years (p=0.7715).
Percutaneous transforaminal endoscopic discectomy is a safe and effective minimally invasive surgery for radiculopathy caused by lumbar disc herniation. Epidural steroid injection following the surgical procedure offered no benefit compared with surgery alone.
比较经皮椎间孔镜下椎间盘切除术联合与不联合硬膜外注射类固醇治疗腰椎间盘突出症的疗效。
回顾性分析101例有经皮椎间孔镜下椎间盘切除术指征的患者。根据手术后是否应用硬膜外类固醇将患者分为两组。A组的每位患者在手术后通过工作套管接受40mg曲安奈德的硬膜外注射。然而，B组患者未使用该药物。术前和术后采用视觉模拟量表（VAS）测量神经根性疼痛。分别采用Oswestry功能障碍指数（ODI）和改良MacNab标准评估功能和满意度。
共有97例患者获得了超过两年的完整随访且无复发。A组和B组的样本量分别为56例和41例。各术后随访点的VAS评分和ODI评分均显著低于术前值（p<0.001）。然而，组间差异无统计学意义（p>0.05）。在3个月和2年随访时，两组间VAS和ODI评分变化的次要结局也相当（p>0.05）。两组在2年时的改良MacNab标准差异无统计学意义（p=0.7715）。
经皮椎间孔镜下椎间盘切除术是治疗腰椎间盘突出症所致神经根病的一种安全有效的微创手术。与单纯手术相比，术后硬膜外注射类固醇并无益处。
