Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan.
Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8606, Japan.
Medicina (Kaunas). 2020 Dec 18;56(12):710. doi: 10.3390/medicina56120710.
: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. : FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED ( = 39) or MED ( = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); : The median (interquartile range (IQR) Q25-75) operation times for FED and MED were 42 (33-61) and 43 (33-50) minutes, respectively. The median (IQR Q25-75) pre- and postoperative NRS scores for low back pain were 5 (2-7) and 1 (0-4), respectively, for FED and 6 (3-8) and 1 (0-2), respectively, for MED. The median (IQR Q25-75) pre- and postoperative NRS scores for leg pain were 7 (5-8) and 0 (0-2), respectively, for FED and 6 (5-8) and 0 (0-2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25-75) DHI ratios of FED and MED were 0.94 (0.89-1.03) and 0.90 (0.79-0.95), respectively. The DHI ratio was significantly higher ( < 0.05) in the FED group than in the MED group, and there was less blood loss; : The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.
: 腰椎间盘突出症（LDH）是生命经脉中的常见病。尽管手术椎间盘切除术常用于治疗 LDH，但有几种不同的策略。我们比较了单通道全内窥镜椎间盘切除术（FED）与显微镜下椎间盘切除术（MED）治疗 LDH 的结果。: FED 使用 4.1 毫米工作通道内窥镜进行，MED 使用 16 毫米直径管状牵开器和内窥镜进行。回顾性分析了由同一位外科医生采用 FED（n = 39）或 MED（n = 27）治疗的 LDH 患者的数据。收集患者背景信息和手术数据。使用数字评分量表（NRS）评分评估术前和术后腰痛和腿痛。从平片计算术前和术后椎间盘高度指数（DHI）值，并使用比值（DHI 比值）评估椎间盘高度损失；: FED 和 MED 的中位（四分位距（IQR）Q25-75）手术时间分别为 42（33-61）和 43（33-50）分钟。FED 和 MED 的术前和术后腰痛 NRS 评分中位数（IQR Q25-75）分别为 5（2-7）和 1（0-4）和 6（3-8）和 1（0-2）。FED 和 MED 的术前和术后腿痛 NRS 评分中位数（IQR Q25-75）分别为 7（5-8）和 0（0-2）和 6（5-8）和 0（0-2）。这些数据在 FED 和 MED 组之间没有差异。FED 和 MED 的 DHI 比值中位数（IQR Q25-75）分别为 0.94（0.89-1.03）和 0.90（0.79-0.95）。FED 组的 DHI 比值明显高于 MED 组（<0.05），且出血量较少；: FED 治疗 LDH 的止痛效果几乎与 MED 相同。然而，FED 在预防椎间盘高度丢失方面优于 MED，椎间盘高度丢失是术后椎间盘退变的指标之一。
