Yang Shu-Qing, Zhang Shi-Min, Wu Guan-Nan, Jin Jiao, Lin Hai
The First Department of Spinal Surgery, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100102, China.
Zhongguo Gu Shang. 2020 Jul 25;33(7):621-7. doi: 10.12200/j.issn.1003-0034.2020.07.006.
To explore clinical efficacy of percutaneous endoscopic lumbar discectomy through two different approaches in treating upper lumbar disc herniation.
From March 2015 to August 2019, 32 patients with upper lumbar disc herniation treated by percutaneous endoscopic lumbar dicecromy(PELD) were analyzed retrospectively and divided into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) group according to different methods. There were 19 patients in PETD group, including 10 males and 9 females aged from 30 to 65 years old with an average of (44.70±12.08) years old;5 patients on L, 6 patients on L, 8 patients on L;6 patients were central herniation, 8 patients were paracentric herniation, and 5 patients were migration of herniation. There were 13 patients in PEID group, including 4 males and 9 females aged from 25 to 55 years old with an average of (42.23±12.09) years old;the courses of disease ranged from 1 to 7 months with an average of (2.90±3.02) months;3 patients on L, 4 patients on L, 6 patients on L;2 patients were central herniation, 4 patients were paracentric herniation, 3 patients were migration of herniation, 4 patients were prolapse free type protrusion. VAS and ODI score before operation, postoperative at 3 days, 3 and 6 months were compared between two groups, advanced MacNab standard at 1 year after operation were applied to evaluate clinical effects.
Operation were successful operated in 32 patients and obtained following up without nerve injury and infection of intervertebral space. One patient in PETD groups occurred dural sac tear in operation, but no adverse reaction afteroperation. PETD group was followed up from 12 to 24 months with an average of (15.80±3.48) months, while PEID group was followed up from 12 to 30 months with an average of (16.70±4.66) months, while there was no statistical difference between two groups (>0.05). VAS and ODI score at different time points after operation were higher than that of before operation (<0.05). According to advanced MacNab standard at 1 year after operation, 11 patients obtained excellent results, 6 good, 1 moderate and 1 poor in PETD group;while 7 patients got excellent results, 4 good, 2 moderate in PEID group.
Both of two surgical approach could achieve satisfactory efficacy in treating upper lumbar disc herniation, PETD is more suitable for central herniation, paracentric herniation and patients with mild displacement, PEID has advantage on prolapse free type protrusion.
探讨经两种不同入路的经皮内镜下腰椎间盘切除术治疗上位腰椎间盘突出症的临床疗效。
回顾性分析2015年3月至2019年8月采用经皮内镜下腰椎间盘切除术（PELD）治疗的32例上位腰椎间盘突出症患者，并根据不同方法分为经皮内镜下椎间孔入路椎间盘切除术（PETD）组和经皮内镜下椎板间入路椎间盘切除术（PEID）组。PETD组19例，男10例，女9例，年龄30～65岁，平均（44.70±12.08）岁；L1节段5例，L2节段6例，L3节段8例；中央型突出6例，旁中央型突出8例，脱出型突出5例。PEID组13例，男4例，女9例，年龄25～55岁，平均（42.23±12.09）岁；病程1～7个月，平均（2.90±3.02）个月；L1节段3例，L2节段4例，L3节段6例；中央型突出2例，旁中央型突出4例，脱出型突出3例，游离型突出4例。比较两组患者术前、术后3天、3个月及6个月的视觉模拟评分（VAS）和腰椎功能障碍指数（ODI），采用改良MacNab标准于术后1年评估临床疗效。
32例患者手术均成功，术后均获得随访，无神经损伤及椎间隙感染发生。PETD组1例患者术中出现硬脊膜撕裂，但术后无不良反应。PETD组随访12～24个月，平均（15.80±3.48）个月；PEID组随访12～30个月，平均（16.70±4.66）个月，两组比较差异无统计学意义（P>0.05）。两组患者术后不同时间点的VAS和ODI评分均高于术前（P<0.05）。术后1年采用改良MacNab标准评估，PETD组优11例，良6例，可1例，差1例；PEID组优7例，良4例，可2例。
两种手术入路治疗上位腰椎间盘突出症均能取得满意疗效，PETD更适合中央型、旁中央型及轻度移位患者，PEID在游离型突出方面具有优势。
