经皮椎间孔镜下椎间盘切除术治疗多节段腰椎间盘突出症的疗效及安全性评估
Evaluation of the efficacy and safety of percutaneous transforaminal endoscopic discectomy for multi-segmental lumbar disc herniation.
作者信息
Zhao Ya-Fei, Tian Bin-Wu, Ma Qiu-Shuang, Zhang Meng
机构信息
Ya-fei Zhao, Department of Orthopedics, Baoding No.1 Hospital of Traditional Chinese Medicine, Baoding 071000, Hebei, P.R. China.
Bin-wu Tian, Department of Orthopedics, Baoding No.1 Hospital of Traditional Chinese Medicine, Baoding 071000, Hebei, P.R. China.
出版信息
Pak J Med Sci. 2023 Nov-Dec;39(6):1626-1630. doi: 10.12669/pjms.39.6.3399.
OBJECTIVE
To investigate the clinical efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of multi-segmental lumbar disc herniation (msLDH).
METHODS
From January 2021 to December 2021, 75 patients with msLDH admitted to Baoding No.1 Hospital of Traditional Chinese Medicine were selected and divided into PTED group (n=40) and posterior lumbar interbody fusion (PLIF) group (n=35) according to different surgical methods. The operative time, intraoperative blood loss, surgical complications, Oswestry disability index (ODI) and Japanese Orthopedic Association score (JOA) scores were compared between the two groups.
RESULTS
In the PTED group, the average operation time was 57.45±12.01minutes, and the average intraoperative blood loss was 50.57±16.69ml. There were three patients with surgical complications, including one case of hematoma, one case of aggravation of neurological symptoms and one case of new onset of neurological symptoms. In the PLIF group, there were 12 cases undergoing single-segment operation, 15 cases undergoing double-segment operation and 8 cases undergoing three-segment operation, the average operation time was 137.26±34.64minutes, and the average intraoperative blood loss was 456.06±33.06ml, there were four cases of wound fat liquefaction or delayed healing, two cases of hematoma, and three cases of exacerbation of original neurological symptoms or new neurological symptoms. At one month, six months, and one year of postoperative, the ODI and JOA scores of the two groups were significantly improved compared with those preoperative, and the ODI scores of the PTED group were better than those of the PLIF group (t=3.131, 2.263, 3.768, all P<0.05).
CONCLUSION
The surgical effect of PTED in the treatment of LDH is similar to that of PLIF. However, PTED has the advantages of short operation time, less blood loss, fewer surgical complications, and high surgical safety. It is worthy of clinical promotion.
目的
探讨经皮椎间孔镜下椎间盘切除术（PTED）治疗多节段腰椎间盘突出症（msLDH）的临床疗效及安全性。
方法
选取2021年1月至2021年12月保定市第一中医院收治的75例msLDH患者，根据不同手术方式分为PTED组（n = 40）和后路腰椎椎间融合术（PLIF）组（n = 35）。比较两组手术时间、术中出血量、手术并发症、Oswestry功能障碍指数（ODI）及日本骨科学会评分（JOA）。
结果
PTED组平均手术时间为57.45±12.01分钟，平均术中出血量为50.57±16.69毫升。有3例手术并发症，包括1例血肿、1例神经症状加重和1例新发神经症状。PLIF组中，单节段手术12例，双节段手术15例，三节段手术8例，平均手术时间为137.26±34.64分钟，平均术中出血量为456.06±33.06毫升，有4例伤口脂肪液化或延迟愈合，2例血肿，3例原有神经症状加重或出现新的神经症状。术后1个月、6个月和1年时，两组ODI和JOA评分均较术前显著改善，且PTED组ODI评分优于PLIF组（t = 3.131、2.263、3.768，均P<0.05）。
结论
PTED治疗LDH的手术效果与PLIF相似。然而，PTED具有手术时间短、出血量少、手术并发症少及手术安全性高的优点。值得临床推广。
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