| 椎间孔镜下经椎板间入路髓核摘除术与开窗髓核摘除术治疗L5S1椎间盘突出的疗效分析 |
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投稿时间：2019-01-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 颜廷振 |
YAN Ting-zhen |
济宁市第一人民医院脊柱外科, 山东 济宁 272111 |
Department of Spinal Surgery, the First People`s Hospital of Jining, Jining 272111, Shandong, China |
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| 吕超亮 |
LYU Chao-liang |
济宁市第一人民医院脊柱外科, 山东 济宁 272111 |
Department of Spinal Surgery, the First People`s Hospital of Jining, Jining 272111, Shandong, China |
lvchaolianggk@163.com |
| 魏彦春 |
WEI Yan-chun |
济宁市第一人民医院脊柱外科, 山东 济宁 272111 |
Department of Spinal Surgery, the First People`s Hospital of Jining, Jining 272111, Shandong, China |
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| 牛士贞 |
NIU Shi-zhen |
济宁市第一人民医院脊柱外科, 山东 济宁 272111 |
Department of Spinal Surgery, the First People`s Hospital of Jining, Jining 272111, Shandong, China |
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| 孙国庆 |
SUN Guo-Qing |
济宁市第一人民医院脊柱外科, 山东 济宁 272111 |
Department of Spinal Surgery, the First People`s Hospital of Jining, Jining 272111, Shandong, China |
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| 期刊信息：《中国骨伤》2019年，第32卷，第10期，第933-936页 |
| DOI：10.3969/j.issn.1003-0034.2019.10.012 |
| 基金项目:山东省自然科学基金（编号：ZR2015YL034） |
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中文摘要:
目的：探讨椎间孔镜下经椎板间入路髓核摘除术与开窗髓核摘除术治疗L5S1椎间盘突出的临床疗效。
方法：回顾性分析2014年1月至2017后3月收治的L5S1椎间盘突出并获得随访患者86例，依据手术方法不同分成椎间孔镜组（43例）及开窗组（43例）。所有手术在全身麻醉下进行，椎间孔镜组采用全脊柱内镜经椎板间入路髓核摘除术（percuteneous endoscopic interlaminar discectomy，PEID），开窗组采用经典开窗髓核摘除术（fenestration discectomy，FD）。比较两组患者的切口长度、手术时间、出血量、住院时间、术后卧床时间、并发症等一般情况，记录手术前后患肢疼痛及腰部疼痛的VAS评分，观察两组患者术后血清肌酸激酶的变化，采用改良的Macnab标准评定疗效，并通过MRI观察术后椎旁肌残存率。
结果：PEID组及FD组皮肤切口长度分别为（0.7±0.1）cm和（5.0±1.8）cm，出血量分别为（8.0±3.0）ml和（62.0±50.5）ml，住院时间分别为（3.0±1.5）d和（11.0±2.5）d，术后卧床时间分别为（1.0±0.5）d和（3.0±0.8）d，两组比较差异有统计学意义（P<0.05）。术后24 h及术后1年两组患肢疼痛VAS评分较术前均明显降低（P<0.05），但组间比较差异无统计学意义（P>0.05）。PEID及FD组术后24 h腰痛VAS评分分别为2.99±0.32和5.44±1.31，术后1年分别为1.56±0.60和3.05±0.24，两组比较差异有统计学意义（P<0.05）。FD组肌酸激酶术后24、48 h较PEID组明显升高（P<0，05）。术后1年，PEID及FD组Macnab优良率分别93%和95%。通过MRI观察，PEID组术后1年椎旁多裂肌残存率明显高于开窗组（P<0.05）。两组患者均未发生硬脊膜撕裂、神经根损伤、血管损伤、椎间隙感染等并发症。
结论：两种方法在治疗L5S1椎间盘突出患者均安全可靠，可取得满意效果，但在椎旁肌保护、手术切口、出血量、住院时间及术后卧床时间等指标上，椎间孔镜更具优势，更符合微创理理念。 |
| 【关键词】椎间盘移位 椎间盘摘除术 经皮内窥镜椎板间入路椎间盘切除术 开窗髓核摘除术 |
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| Comparision of surgical outcomes between percuteneous endoscopic interlaminar discectomy and fenestration discectomy for L5S1 lumbar disc herniation |
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ABSTRACT
Objective:To investigate the clinical effects of percuteneous endoscopic interlaminar discectomy(PEID)and fenestration discectomy(FD) for the treatment of L5S1 lumbar disc herniation(LDH).
Methods:A retrospective analysis was made on 86 patients with L5S1 LDH from January 2014 to March 2017 and followed up. According to the different surgical methods,the patients were divided into PEID group(43 cases) and FD group(43 cases). All operations were performed under general anesthesia. Forty-three patients in PEID group underwent percuteneous endoscopic interlaminar discectomy (PEID) and other 43 patients in FD group underwent classical fenestration discectomy (FD). Operative incision,operative time,intraoperative blood loss,duration of hospitalization,time of lying in bed after surgery,complication were compared between two groups. Pre- and postoperative visual analogue scale(VAS) of affected extremity pain and lumbar pain were recorded. Postoperative creatine kinase (CK) was observed in two groups. Modified Macnab criteria was used to evaluate the clinical effects. MRI was used to observe the survival rate of paraspinal muscle after operation.
Results:The length of skin incision,intraoperative blood loss,duration of hospitalization,time of lying in bed after surgery of PEID group and FD group were(0.7±0.1) cm,(8.0±3.0) ml,(3.0±1.5) d,(1.0±0.5) d and(5.0±1.8) cm,(62.0±50.5) ml,(11.0±2.5) d,(3.0±0.8) d,there was significant differences between two groups(P<0.05). VAS of affected extremity at 24 hours and 1 year after operation was obviously decreased in two groups(P<0.05),but there was no significant difference between groups(P>0.05). VAS of lumbar pain in PEID group and FD group were respectively (2.99±0.32),(5.44±1.31) scores at 24 hours after operation,and (1.56±0.60),(3.05±0.24) at 1 year after operation,there was significant differences between two groups(P<0.05). CK at 24,48 hours after operation of FD group were obviously increased(P<0.05). According the modified Macnab criteria to evaluate the clinical effect,the rate of excellent and good of PEID group and FD group were 93% and 95%,respectively. The survival rate of paraspinal muscle by MRI in PEID group at 1 year after operation was higher than that in FD group(P<0.05). No complications such as spinal dura mater tearing,nerve root injury,vascular injury,intervertebral space infection were found in two groups.
Conclusion:Both of the two methods are safe and can obtain satisfactory effect,but PEID is more in line with concept of minimally invasive and has more advantages in paraspinal muscle protection,operative incision,intraoperative blood loss,duration of hospitalization,time of lying in bed after operation. |
| KEY WORDS Intervertebral disk displacement Discectomy Percuteneous endoscopic interlaminar discectomy Fenestration discectomy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 颜廷振,吕超亮,魏彦春,牛士贞,孙国庆.椎间孔镜下经椎板间入路髓核摘除术与开窗髓核摘除术治疗L5S1椎间盘突出的疗效分析[J].中国骨伤,2019,32(10):933~936 |
| 英文格式: | YAN Ting-zhen,LYU Chao-liang,WEI Yan-chun,NIU Shi-zhen,SUN Guo-Qing.Comparision of surgical outcomes between percuteneous endoscopic interlaminar discectomy and fenestration discectomy for L5S1 lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(10):933~936 |
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