经皮椎间孔镜与Quadrant微创通道下治疗腰椎间盘突出症的临床研究*

Clinical outcomes of percutaneous transforaminal endoscopic discectomy and Quadrant minimally invasive system in treatment of lumbar disc herniation*

摘要:

目的??比较经皮椎间孔镜（PTED）和Quadrant微创通道下手术治疗腰椎间盘突出症（LDH）的临床疗效。方法?将59例单节段LDH患者，随机分为PTED组和Quadrant组。其中，PTED组31例，Quadrant组28例。对两组手术时间、切口长度、失血量、住院天数、返回工作时间及手术并发症进行对比分析。采用视觉疼痛模拟评分（VAS）、日本骨科学会下腰痛评分标准（JOA）、Oswestry功能障碍指数（ODI）及改良MacNab标准评价手术疗效。结果?PTED组与Quadrant组相比手术切口小、术中出血量少、住院天数及返回工作时间上明显缩短（P <0.05），术后两组患者的VAS、JOA和ODI评分得到改善（P <0.05）；而且术后3天、1和3个月，PTED组VAS腰痛评分低于相应时间Quadrant组评分（P <0.05）；两组在术后各随访时间点的JOA和ODI评分无明显差异（P >0.05）。按照改良MacNab标准评定，两组间优良率差异无统计学意义（P >0.05）。结论?PTED和Quadrant通道两种微创术式治疗LDH均能取得满意的临床效果，但PTED手术恢复快、创伤更小。

Abstract:

Objective?To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and Quadrant minimally invasive system in treatment of lumbar disc herniation (LDH).?Methods?59 single-level LDH patients were randomly divided into PTED group (n = 31) and Quadrant group (n = 28). Then compare the operative time, incision length, blood loss, length of hospital stay, and the return-to-work time between the two groups. In addition, visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and modified MacNab criteria were used for surgical efficacy evaluation.?Results?In PTED group, compared with Quadrant group, we observed, shorter incision length, less blood loss, shorter hospital stay, and shorter time of returning to work (P < 0.05), postoperative VAS, JOA and ODI scores had been improved in both groups (P < 0.05). The PTED group had lower VAS scores of lumbago at 3 days and 1, 3 months postoperatively (P < 0.05). As for postoperative JOA and ODI score, no notable difference was found between the two groups at each corresponding follow-up time point (P > 0.05). According to the improved MacNab criteria, there was no significant difference in excellent or good rate between the two groups (P > 0.05).?Conclusion?The clinical results of PTED and Quadrant minimally invasive system in treatment of lumbar disc herniation were satisfactory, and PTED were less traumatic method with rapid recovery.