Department of Orthopaedics, Henan Provincial People's Hospital of Henan University, Zhengzhou, China.
Orthop Surg. 2020 Aug;12(4):1092-1099. doi: 10.1111/os.12698. Epub 2020 Jun 24.
To compare the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) for posterior ring apophyseal fractures (PRAF).
This study was a retrospective cohort control study. A total of 96 patients with lumbar PRAF who underwent surgical treatment at the Henan Provincial People's Hospital of Henan University from September 2013 to December 2017 were retrospectively examined, of which 51 were treated by PTED and 45 by FD. The average age of those in the PTED group was 28.24 years, including 38 males and 13 females. The average age of those in the FD group was 28.07 years, with 33 males and 12 females. Operation time, total blood loss, hospitalization days, preoperative and postoperative visual analog scale (VAS), and Oswestry disability index (ODI) scores were evaluated. Modified MacNab criteria were used to evaluate the clinical effect at the last follow-up.
Both operations were successful and no serious complications occurred. All patients were followed up for 12-30 (average 16.7 ± 3.2) months, and no patients were lost to follow-up. No statistically significant difference was found in the mean age and gender between the PTED group and the FD group (P < 0.05). Operation time, total blood loss, and length of hospital stay were significantly lower in the PTED group (87.65 ± 13.15 min, 12.78 ± 4.95 mL, and 6.80 ± 1.67 days, respectively) than in the FD group (114.11 ± 14.39 min, 30.89 ± 7.09 mL, and 11.71 ± 1.98 days, respectively) (P < 0.05). The VAS and ODI scores of the two groups at postoperative day 1 (PTED: 3.82 ± 0.97, 37.73% ± 3.72%; FD: 3.62 ± 1.09, 36.62% ± 3.05%), and at 3 months (PTED: 2.90 ± 1.08, 26.02% ± 2.90%; FD: 3.07 ± 0.99, 27.16% ± 4.02%), 6 months (PTED: 2.31 ± 0.88, 22.53% ± 2.67%; FD: 2.36 ± 0.77, 21.18% ± 3.35%), and the last follow-up (PTED: 1.90 ± 0.83, 19.88% ± 3.01%; FD: 1.89 ± 0.86, 18.22% ± 3.03%) were significantly different from the preoperative scores (PTED: 6.53 ± 1.00, 55.24% ± 4.54%; FD: 6.78 ± 1.31, 53.56% ± 5.73%) (P < 0.05). The VAS and ODI scores at 3 months postoperatively, 6 months postoperatively, and the last follow up were not significantly different between the two groups (P > 0.05). In the PTED group, 2 patients developed a transient nerve stimulation symptom within 1 day after surgery and 1 patient had recurrence at 3 months after surgery. In the FD group, 2 patients had severe dural ruptures due to adhesion during surgery, 1 patient developed infection complications, and 2 patients relapsed at 2 and 3 months after surgery. At the last follow-up, the modified MacNab criteria for clinical effect were 93.3% and 94.1% in the FD and PTED groups, respectively.
While PTED has the same efficacy as FD for treating PRAF, it is associated with shorter operation time, less trauma, and quicker recovery.
比较经皮椎间孔内窥镜椎间盘切除术（PTED）与开窗椎间盘切除术（FD）治疗腰椎后方环椎弓根骨折（PRAF）的疗效和安全性。
本研究为回顾性队列对照研究。回顾性分析 2013 年 9 月至 2017 年 12 月在河南大学人民医院接受手术治疗的 96 例腰椎 PRAF 患者的临床资料，其中 51 例行 PTED 治疗，45 例行 FD 治疗。PTED 组患者平均年龄 28.24 岁，其中男 38 例，女 13 例；FD 组患者平均年龄 28.07 岁，其中男 33 例，女 12 例。评估手术时间、总失血量、住院天数、术前和术后视觉模拟量表（VAS）评分和 Oswestry 功能障碍指数（ODI）评分。末次随访时采用改良 MacNab 标准评估临床疗效。
两组手术均顺利完成，无严重并发症发生。所有患者均获得 12-30 个月（平均 16.7±3.2）随访，无失访病例。PTED 组与 FD 组患者的平均年龄和性别差异无统计学意义（P<0.05）。PTED 组手术时间、总失血量和住院时间分别为 87.65±13.15 min、12.78±4.95 mL 和 6.80±1.67 d，明显短于 FD 组的 114.11±14.39 min、30.89±7.09 mL 和 11.71±1.98 d（P<0.05）。两组术后第 1 天（PTED：3.82±0.97，37.73%±3.72%；FD：3.62±1.09，36.62%±3.05%）、3 个月（PTED：2.90±1.08，26.02%±2.90%；FD：3.07±0.99，27.16%±4.02%）、6 个月（PTED：2.31±0.88，22.53%±2.67%；FD：2.36±0.77，21.18%±3.35%）和末次随访（PTED：1.90±0.83，19.88%±3.01%；FD：1.89±0.86，18.22%±3.03%）VAS 和 ODI 评分均显著低于术前（PTED：6.53±1.00，55.24%±4.54%；FD：6.78±1.31，53.56%±5.73%）（P<0.05）。两组术后 3 个月、6 个月和末次随访 VAS 和 ODI 评分比较差异无统计学意义（P>0.05）。PTED 组术后 1 天内有 2 例患者出现短暂性神经刺激症状，3 个月时有 1 例患者复发；FD 组有 2 例患者因术中粘连致硬脊膜严重破裂，1 例患者发生感染并发症，2 例患者分别于术后 2 个月和 3 个月复发。末次随访时，FD 组和 PTED 组的改良 MacNab 临床疗效评分分别为 94.1%和 93.3%。
PTED 治疗 PRAF 的疗效与 FD 相同，但手术时间更短、创伤更小、恢复更快。
