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中国全科医学 ›› 2018, Vol. 21 ›› Issue (15): 1813-1817.DOI: 10.3969/j.issn.1007-9572.2018.00.143

• 专题研究 • 上一篇    下一篇

经皮椎间孔镜下髓核摘除术与经椎间孔入路腰椎椎体间融合术治疗极外侧腰椎间盘突出症的临床疗效比较研究

钟远鸣1*，张翼升2，梁梓扬2，李嘉琅2，陈震2   

  1. 1.530023广西南宁市，广西中医药大学第一附属医院骨科（脊柱外科）　2.530001广西南宁市，广西中医药大学研究生院
    *通信作者：钟远鸣，教授，主任医师；E-mail：996913937@qq.com
  • 出版日期:2018-05-20 发布日期:2018-05-20

Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion for Extreme Lateral Lumbar Disc Herniation　

  1. 1.Department of Orthopedics（Spinal Surgery），the First Affiliated Hospital of Guangxi University of Chinese Medicine，Nanning 530023，China
    2.Graduate School，Guangxi University of Chinese Medicine，Nanning 530001，China
    *Corresponding author：ZHONG Yuan-ming，Professor，Chief physician；E-mail：996913937@qq.com
  • Published:2018-05-20 Online:2018-05-20

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摘要： 目的　比较经皮椎间孔镜下髓核摘除术与经椎间孔入路腰椎椎体间融合术（TLIF）治疗极外侧腰椎间盘突出症（ELLDH）的临床疗效。方法　回顾性分析2014年9月—2016年9月广西中医药大学第一附属医院骨科（脊柱外科）符合纳入标准的45例ELLDH患者的临床资料。其中采用经皮椎间孔镜下髓核摘除术治疗的患者24例（A组），采用TLIF治疗的患者21例（B组）。记录患者一般资料、不同时间点（术前、术后即刻、术后1周、术后1个月及末期随访时）的视觉模拟评分法（VAS）、腰椎功能日本骨科学会（JOA）、Oswestry功能障碍指数问卷表（ODI）评分及临床疗效。结果　B组手术时间、卧床时间、出院时间、恢复日常生活时间长于A组，术中出血量、皮肤切口长度、住院费用大于A组（P<0.05）。时间与手术方式在VAS、ODI评分上存在交互作用（P<0.05），在腰椎功能JOA评分上不存在交互作用（P>0.05）；时间、手术方式在VAS、腰椎功能JOA、ODI评分上主效应显著（P<0.05）。A、B组术后即刻、术后1周、术后1个月、末期随访时的VAS、ODI评分均小于术前，腰椎功能JOA评分均大于术前 （P<0.05）；B组术后即刻、术后1周的VAS、ODI评分均大于A组，腰椎功能JOA评分均小于A组（P<0.05）。A组优良率大于B组（P<0.05）。结论　经皮椎间孔镜下髓核摘除术可有效代替TLIF治疗ELLDH，其具有创伤小、恢复快、住院时间短等优点，且疗效明显，是一种安全有效的微创手术技术，值得临床广泛推广。

关键词: 椎间盘移位, 椎间盘切除术, 经皮, 疗效比较研究, 经椎间孔入路腰椎椎体间融合术

Abstract: Objective　To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy（PELD） and transforaminal lumbar interbody fusion（TLIF） for the treatment of extreme lateral lumbar disc herniation（ELLDH）．Methods　Study design was retrospective.45 cases of ELLDH were enrolled based on the inclusion criteria of this study from Department of Orthopedics（Spinal Surgery），the First Affiliated Hospital of Guangxi University of Chinese Medicine from September 2014 to September 2016，including 24 treated by PELD and 21 treated by TLIF．By reviewing the medical records，we collected their demographic characteristics，results of visual analogue scale（VAS） score，Japanese Orthopedic Association（JOA） score and Oswestry Disability Index（ODI） score assessed at 5 time points（before surgery，immediately after surgery，1 week，1 month after surgery，and the last follow-up） as well as clinical response to surgery.Results　Compared with those receiving PELD，the mean duration of surgery，period of bed rest，length of stay，time needed to return to the normal daily life activities and incision length were longer，the mean amount of intraoperative blood loss and hospitalization cost were greater in patients receiving TLIF（P<0.05）．Duration and mode of surgery exerted interaction effects on VAS score and ODI score（P<0.05），but not on JOA score（P>0.05）．Duration and mode of surgery produced main effects on VAS score，JOA score and ODI score（P<0.05）．Compared with baseline，the mean VAS score and ODI score were less and mean JOA score was greater assessed at each time point postoperatively in both groups（P<0.05）．Compared with those treated by PELD，the mean VAS score and ODI score were greater，but mean JOA score was less at immediately after surgery，and at 1 week after surgery in patients receiving TLIF（P<0.05）．Excellent and good response to surgery was achieved in patients receiving PELD rather than those receiving TLIF（P<0.05）．Conclusion　PELD is a safe and effective minimally invasive surgery for ELLDH.Compared with TLIF，using it，the incision length can be less，the postoperative recovery can be rapider，and the length of stay can be shorter.Therefore，it is recommended for wide clinical application.

Key words: Intervertebral disc displacement；Diskectomy, percutaneous；Comparative effectiveness research；Transforaminal lumbar interbody fusion

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