经皮内窥镜腰椎间盘切除术与微创经皮内窥镜腰椎间盘切除术治疗腰椎间盘突出症的日间手术疗效比较。

Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation.

机构信息

Spine Surgery Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China.

Medical Record Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China.

出版信息

BMC Musculoskelet Disord. 2021 Feb 9;22(1):160. doi: 10.1186/s12891-021-04038-6.

BACKGROUND

Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD.

METHODS

A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared.

RESULTS

Patients treated by PELD had lower blood loss and shorter hospital stay (P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014).

CONCLUSIONS

Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.

背景

经皮内镜腰椎间盘切除术（PELD）对住院腰椎间盘突出症（LDH）患者效果满意。目前，仅有少数研究报道了日间手术患者行 PELD 的情况。

方法

共 267 例 LDH 患者行日间手术 PELD，随访至少 3 年。采用腿痛视觉模拟评分（VAS）和腰痛 VAS（VAS-B 和 VAS-L）、Oswestry 功能障碍指数（ODI）评估临床疗效。记录并比较腰椎前凸角（LL）、骶骨倾斜角（SS）、椎间盘高度比和椎间盘不稳等影像学结果。比较日间手术 PELD 治疗与同期住院的 116 例 LDH 患者行微创经皮内镜椎间盘切除术（MED）的临床效果。

结果

与 MED 组相比，PELD 组术中出血量更少，住院时间更短（P<0.001）。与术前及术后 3 年相比，PELD 组术后腿痛 VAS-L、VAS-B 和 ODI 均显著降低。与 MED 组相比，PELD 组术后腿痛 VAS-B 明显降低（P=0.001）。PELD 组并发症发生率为 9.4%，MED 组为 12.1%（P=0.471）。PELD 组术后 1 年复发率明显高于 MED 组（P=0.042）。与 MED 组相比，PELD 组术后 LL 和 SS 明显改善（P<0.001）。随访 3 年时，MED 组椎间盘高度比明显降低，而 PELD 组则无明显变化（P=0.014）。