运用椎间孔镜术和开放式椎间盘切除术治疗青少年腰椎间盘突出症疗效研究

An Efficacy Study about Percutaneous Transforaminal Endoscopic Discectomy and Open Microdiscectomy for Lumbar Disc Herniation

摘要: 目的：比较经皮椎间孔镜下腰椎间盘髓核摘除术(PTED)和开放腰椎间髓核摘除术(OM)治疗青少年腰椎间盘突出症的临床疗效。方法：回顾性分析2015年1月至2018年1月荆州市第三人民医院脊柱外科诊断单节段腰间盘突出症的，符合纳入标准的48例青少年患者，其中经皮椎间孔镜组(PTED组)患者28例，开放组(OM组)患者20例。比较两种术式的切口长度、手术时间、出血量和住院时间，记录并比较两组患者术前，术后1周、24周的视觉疼痛模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科学会评分(JOA)。术后一周自身满意度，1年随访时的腰椎功能采用改良MacNab评价标准进行评价。结果：两组患者均顺利完成手术及随访。两组的手术切口长度、手术时间、出血量和住院时间比较差异均有统计学意义(均P < 0.01)。两组患者术后1周、24周ODI、VAS、JOA与术前比较,均明显改善(P < 0.05)，按照改良的MacNab标准评定两组术后1年的疗效优良率差异无统计学意义(P > 0.05)。结论：椎间孔镜和椎板开窗均能有效治疗青少年腰椎间盘突出症，PTED组具有手术创伤小、安全，术后恢复快、住院时间短，为治疗青少年椎间盘提供多一种选择，值得临床推广应用。

Abstract: Objective: To compare the preliminary clinical outcomes of percutaneous transforaminal endo-scopic discectomy (PTED) and open microdiscectomy (OM) for lumbar disc herniation in the ado-lescents and further to summarize the clinical experience. Methods: The data of 48 patients with single segment Lumbar disc hemiation who were adopted by our department from January 2015 to January 2018 were retrospectively studied. All patients were divided into 2 groups, including 28 patients undergoing FTED and 20 patients undergoing OM respectively. The factors including the length of skin incision, amount of intraoperative bleeding, operation time and duration of hospitalization were compared. Pfirrmann grading system was used for assessment of lumbar dise degeneration preoperatively and 1 year later. The visual analog e scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopedic Association (J0A) scores were used to measure the clinical outcomes. Results: There were significant differences in the observation factors such as the skin incision length, amount of intraoperative bleeding, operation time and duration of hospitalization between the PTED and OM groups (P < 0.05). After surgery, the patients in both groups were fol-lowed up for 12 months on average respectively. The postoperative lumbar disc degeneration in PTED group was deceased than that of in OM group. The postoperative VAS scores, ODI and JOA scores at each follow-up time point in both groups were significantly improved when compared with the preventive ones (P < 0.05). There were no statistically significant differences between the 2 groups in the JOA score improvement rate (P > 0.05). According to the modified MacNab criteria, there were no statistically significant differences between the 2 groups in the excellent and good rate (P > 0.05). Conclusions: The preliminary clinical efficacy of both PTED and OM in the treatment of single segment lumbar disc herniation in the adolescents is satisfactory. However, PTED is a better minimally invasive surgical method with such advantages as fewer traumas, less blood loss, early function recovery less effect on lumbar spinal stability and so on. It provides more than one for the treatment of intervertebral discs in adolescents. The choice is worthy of clinical popu-larization and application.