Zhong Wei-Jian, Li Shun-Ping, Wang Yun-Na, Deng Xiao-Bo, Hong Zhong, Lu Zhi-You
Department of Orthopaedics, the First People's Hospital of Nankang District, Ganzhou 341000, Jiangxi, China.
Department of Rehabilitation, the First People's Hospital of Nankang District, Ganzhou 341000, Jiangxi, China.
Zhongguo Gu Shang. 2023 Jan 25;36(1):12-6. doi: 10.12200/j.issn.1003-0034.2023.01.003.
To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy (VPTED) and traditional percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation.
The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December, 2020 was retrospectively analyzed. There were 38 males and 22 females, aged from 26 to 58 years old with an average of (43.63±8.48) years, 47 cases were on L segment and 13 cases were on LS segment. Among them, 32 were treated with VPTED (group A) and 28 were treated with traditional PTED (group B). The general conditions of all the patients were recorded, including intraoperative fluoroscopy times, operation time, hospital stay and surgical complications during follow-up. The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score of low back pain, Oswestry disability index (ODI) were used to evaluate the clinical efficacy between two groups.
All patients were followed up from 9 to 15 months with an average of (12.10±1.16) months. There was no statistical difference of preoperative general data between two groups. The operation time, fluoroscopy times and hospital stay were (70.47±5.87) min, (13.66±1.34) times and (6.31±0.69) d in group A, and (90.71±7.66) min, (22.82±2.48) times and (6.54±0.92) d in group B. The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(<0.05). There was no significant difference in hospital stay between two groups (>0.05). No obvious surgical complications were found during the follow-up in both groups. The arthroplasty area ratio in group A was (29.72±2.84)% and (29.57±2.20)% in group B, respectively, with no significant difference (>0.05). There was no significant difference in VAS, ODI and JOA score between two groups before operation and at the final follow-up(>0.05), but the final follow-up was significantly improved(<0.05).
The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation. Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel, and can significantly reduce the operation time and intraoperative fluoroscopy times.
比较可视化环锯成形术辅助经皮椎间孔镜下椎间盘切除术（VPTED）与传统经皮椎间孔镜下椎间盘切除术（PTED）治疗腰椎间盘突出症的临床疗效。
回顾性分析2019年6月至2020年12月收治的60例腰椎间盘突出症患者的临床资料。其中男38例，女22例，年龄26～58岁，平均（43.63±8.48）岁；L节段47例，LS节段13例。其中32例行VPTED治疗（A组），28例行传统PTED治疗（B组）。记录所有患者的一般情况，包括术中透视次数、手术时间、住院时间及随访期间的手术并发症。在椎间孔中间水平通过矢状面CT观察成形术面积比。采用视觉模拟评分法（VAS）、日本骨科学会（JOA）下腰痛评分、Oswestry功能障碍指数（ODI）评估两组临床疗效。
所有患者随访9～15个月，平均（12.10±1.16）个月。两组术前一般资料比较差异无统计学意义。A组手术时间、透视次数及住院时间分别为（70.47±5.87）min、（13.66±1.34）次、（6.31±0.69）d，B组分别为（90.71±7.66）min、（22.82±2.48）次、（6.54±0.92）d。A组手术时间及术中透视次数低于B组（<0.05）。两组住院时间比较差异无统计学意义（>0.05）。随访期间两组均未发现明显手术并发症。A组成形术面积比为（29.72±2.84）%，B组为（29.57±2.20）%，差异无统计学意义（>0.05）。两组术前及末次随访时VAS、ODI及JOA评分比较差异无统计学意义（>0.05），但末次随访时均较术前明显改善（<0.05）。
两种手术方法治疗腰椎间盘突出症均有确切临床疗效。可视化环锯成形术辅助经皮椎间孔镜下椎间盘切除术在建立通道时有高效、快速的优点，可明显缩短手术时间及术中透视次数。
