Jiang Yong, He Sheng-Hua, Lai Ju-Yi, Feng Hua-Long, Hong Qiang, Lan Zhi-Ming
Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen 518033, Guangdong, China.
Zhongguo Gu Shang. 2020 May 25;33(5):406-13. doi: 10.12200/j.issn.1003-0034.2020.05.004.
To analyze the clinical effects, complications and operational key points of the percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating LS disc herniation.
The clinical data of 158 patients with L5S1 disc herniation treated from July 2015 to March 2018 were restospectively analyzed. According to different surgical approaches, the patients were divided into PETD group or PEID group, 79 cases in each group. In PETD group, there were 41 males and 38 females, with an average age of (41.38±6.25) years and course of disease of (10.06±3.14) months. In PEID group, there were 43 males and 36 females, with an average age of (41.18±5.78) years and course of disease of (9.99±2.83) months. The operation length, intraoperative blood loss, intraoperative fluoroscopy times, days of hospital stay, and complications were recorded between two groups. Visual analogue score (VAS), Japanese Orthopedic Association(JOA) score, Oswestry Disability Index(ODI), modified Macnab criteria were used to assessed clinical effects after operation.
All patients completed surgery and were followed up for more than 1 year. (1) There were no significant differences in the intraoperative blood loss or hospitalization length between two groups(>0.05). The operation length and intraoperative fluoroscopy times in PETD group were significantly higher than in PEID group (<0.05). (2)VAS, JOA scores, ODI at 1 week, 6 months, or 12 months after operation were significantly improved between two groups (<0.05), but there was no statistical significance between two groups(>0.05). (3)The excellence rate was 89.87% (71 / 79) in PETD group and 87.34% (69 / 79) in PEID group at the latest follow-up, with no statistical significance(>0.05). (4)Complications occurred in 2 cases in PETD group and in 3 cases in PEID group, with no significant differences between two groups.
The short term efficacy of the PETD is equal to that of the PEID for the LS disc herniation, but PEID is superior in the operation length, the access of stereotaxic puncture and intraoperative fluoroscopy times. The complications can be effectively reduced by following the indications, mastering the endoscopic technique, operating carefully and being familiar with the key points of common complications.
分析经皮内镜椎间孔入路椎间盘切除术（PETD）与经皮内镜椎板间入路椎间盘切除术（PEID）治疗腰5骶1椎间盘突出症的临床疗效、并发症及手术要点。
回顾性分析2015年7月至2018年3月收治的158例腰5骶1椎间盘突出症患者的临床资料。根据手术入路不同，将患者分为PETD组和PEID组，每组79例。PETD组男41例，女38例，平均年龄（41.38±6.25）岁，病程（10.06±3.14）个月。PEID组男43例，女36例，平均年龄（41.18±5.78）岁，病程（9.99±2.83）个月。记录两组手术时间、术中出血量、术中透视次数、住院天数及并发症情况。采用视觉模拟评分法（VAS）、日本骨科学会（JOA）评分、Oswestry功能障碍指数（ODI）、改良Macnab标准评估术后临床疗效。
所有患者均完成手术，随访1年以上。（1）两组术中出血量及住院时间比较差异无统计学意义（>0.05）。PETD组手术时间及术中透视次数明显高于PEID组（<0.05）。（2）两组术后1周、6个月、12个月的VAS、JOA评分、ODI均较术前明显改善（<0.05），但组间比较差异无统计学意义（>0.05））。（3）末次随访时，PETD组优良率为89.87%（71/79），PEID组为87.34%（69/79），组间比较差异无统计学意义（>0.05）。（4）PETD组2例发生并发症，PEID组3例发生并发症，两组比较差异无统计学意义。
PETD与PEID治疗腰5骶1椎间盘突出症的短期疗效相当，但PEID在手术时间、立体定向穿刺入路及术中透视次数方面更具优势。严格掌握手术适应证，熟练掌握内镜技术，术中操作仔细，熟悉常见并发症的处理要点，可有效减少并发症的发生。
