Lin Chang-Hao, Huang Yi-Hung, Lien Fang-Chieh, Wu Cheng-Yi, Chao Lin-Yu
Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Tzu Chi Med J. 2023 Feb 13;35(3):237-241. doi: 10.4103/tcmj.tcmj_262_22. eCollection 2023 Jul-Sep.
This study compared the risk of symptomatic recurrent disc herniation and clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus open lumbar microdiscectomy (OLM) for lumbar disc herniation with 2 years of follow-up.
We analyzed 23 patients who underwent PELD and 32 patients who underwent OLM for lumbar disc herniation. The numeric rating scale of back and leg pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were assessed before and at 12 and 24 months after the surgery. The wound pain and complications were also recorded. Survival analysis was performed to estimate the risk of symptomatic recurrent disc herniation.
In the comparison of groups, the reductions in back and leg pain, ODI, and RMDQ were not significantly different at 12 and 24 months. For patients who underwent PELD, the wound pain was significant lower at the day of surgery. The survival rate of patients who were free from symptomatic recurrent disc herniation at 24 months was 0.913 in PELD and 0.875 in OLM, and the log-rank test revealed no significant difference between the two survival curves. The incidence of complication was not significantly different between groups.
Both PELD and OLM are effective treatments for lumbar disc herniation because they have similar clinical outcomes. PELD provided patients with less painful wounds. The survival analysis revealed that the risk of symptomatic recurrent disc herniation in 2 years of follow-up was not different between PELD and OLM.
本研究比较了经皮内镜下腰椎间盘切除术（PELD）与开放式腰椎显微椎间盘切除术（OLM）治疗腰椎间盘突出症并随访2年的症状性复发性椎间盘突出风险及临床结果。
我们分析了23例行PELD的患者和32例行OLM的腰椎间盘突出症患者。在手术前以及术后12个月和24个月评估背痛和腿痛的数字评分量表、Oswestry功能障碍指数（ODI）和罗兰-莫里斯功能障碍问卷（RMDQ）。还记录了伤口疼痛和并发症情况。进行生存分析以估计症状性复发性椎间盘突出的风险。
在组间比较中，12个月和24个月时背痛、腿痛、ODI和RMDQ的降低无显著差异。对于接受PELD的患者，手术当天的伤口疼痛明显较轻。24个月时无症状性复发性椎间盘突出患者的生存率在PELD组为0.913，在OLM组为0.875，对数秩检验显示两条生存曲线之间无显著差异。组间并发症发生率无显著差异。
PELD和OLM都是治疗腰椎间盘突出症的有效方法，因为它们具有相似的临床结果。PELD给患者带来的伤口疼痛较轻。生存分析显示，在2年的随访中，PELD和OLM的症状性复发性椎间盘突出风险没有差异。
