经皮内窥镜腰椎间盘切除术与传统开放手术治疗腰椎间盘突出症的临床疗效比较研究。

A comparative study on the clinical efficacy of percutaneous endoscopic lumbar discectomy and conventional open surgery in the treatment of lumbar disc herniation.

作者信息

Li Zheng, Jiang Chen-Yang, Xu Bao-Shan

机构信息

Zheng Li, Department of Orthopaedics, Tianjin Medical University, Tianjing 300203, China.

Chen-yang Jiang, Department of Orthopaedics, Baoding No.1 Hospital, Baoding, Hebei, 071000, P.R. China.

出版信息

Pak J Med Sci. 2024 Jan-Feb;40(3Part-II):297-302. doi: 10.12669/pjms.40.3.6678.

DOI:10.12669/pjms.40.3.6678

PMID:38356797

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10862464/

Abstract

OBJECTIVE

To analyze the efficacy of single-channel percutaneous endoscopic lumbar discectomy (PELD) and conventional open surgery in the treatment of lumbar disc herniation (LDH).

METHODS

This is a retrospective study. A total of 66 patients with LDH admitted to Tianjin Medical University from June 2017 to June 2018 were divided into two groups: the observation group (single-channel PELD) and the control group (posterior lumbar interbody fusion), with 33 cases in each group. The two groups were compared in terms of visual analogue scale(VAS), oswestry disability index (ODI), Japanese Orthopaedic Association Score(JOA), perioperative indicators, clinical efficacy, postoperative complications, changes in inflammatory factors and serum T lymphocyte subsets.

RESULTS

The operation time, incision length, intraoperative blood loss, time in bed, hospital stay in the observation group were all lower than those in the control group. At 7d after treatment, the improvement of ODI, VAS and JOA in the observation group were better than that in the control group. At the last follow-up, there was no significant difference in Cobb angle and lumbar lordosis angle between the two groups. The levels of serum IL-1, IL-6 and TNF-α in the observation group were lower than those in the control group. The degree of reduction of serum CD3+ and CD4+ in the observation group were higher than those in the control group. And the level of elevation of CD8 in the observation group was lower than that in the control group. Moreover, there was no significant difference in CD4+/CD8+ level between the two groups. The excellent rate of surgical results in the observation group was higher than that in the control group. Complications occurred in both groups, with no significant difference between the two groups.

CONCLUSIONS

Single-channel PELD can achieve superior clinical efficacy over conventional open surgery in the treatment of LDH.

摘要

目的

分析单通道经皮内镜下腰椎间盘切除术（PELD）与传统开放手术治疗腰椎间盘突出症（LDH）的疗效。

方法

本研究为回顾性研究。选取2017年6月至2018年6月在天津医科大学收治的66例LDH患者，分为观察组（单通道PELD）和对照组（后路腰椎椎间融合术），每组33例。比较两组患者的视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、日本骨科学会评分（JOA）、围手术期指标、临床疗效、术后并发症、炎症因子变化及血清T淋巴细胞亚群。

结果

观察组手术时间、切口长度、术中出血量、卧床时间、住院时间均低于对照组。治疗后7天，观察组ODI、VAS及JOA的改善情况优于对照组。末次随访时，两组Cobb角和腰椎前凸角差异无统计学意义。观察组血清IL-1、IL-6及TNF-α水平低于对照组。观察组血清CD3+和CD4+降低程度高于对照组，CD8升高水平低于对照组。两组CD4+/CD8+水平差异无统计学意义。观察组手术效果优良率高于对照组。两组均有并发症发生，两组间差异无统计学意义。