椎间孔镜与通道下腰椎间盘切除术的比较△（开放获取）

Percutaneous transforaminal endoscopic discectomy versus quadrant channel discectomy for lumbar discectomy

摘要:

[目的] 比较经皮椎间孔镜椎间盘切除（percutaneous transforaminal endoscopic discectomy, PTED） 与四分通道椎间盘切除（quadrant channel discectomy, QCD） 治疗腰椎间盘突出症的疗效。[方法] 回顾性分析2022 年度本科收治的单节段腰椎间盘突出症78 例患者的临床资料。根据术前医患沟通结果，40 例采用PTED，另外38 例采用QCD 组。比较两组围手术期、随访和影像资料。[结果] 所有患者均顺利完成手术，均无严重并发症。尽管PTED 组在手术手术时间[(65.7±6.4) min vs (34.2±6.7) min, P=0.027] 和X 线透视次数[(6.8±1.0) 次vs (2.4±1.0) 次, P=0.004] 显著大于QCD 组，但PTED 的切口长度[(0.8±0.2) cm vs(2.3±0.2) cm, P＜0.001]、术中出血量[(31.6±10.2) ml vs (54.8±11.4) ml, P=0.004] 和术后卧床时间[(2.0±0.6) d vs (3.5±0.5) d, P＜0.001]均显著小于QCD 组。随着时间的推移，两组的腰部与腿部VAS 评分和ODI 评分均显著降低（P＜0.05），但相应时间点两组间的差异均无统计学意义（P＞0.05）。影像方面，两组患者术后病变节段椎管占位率均显著减少（P＜0.05），但椎间隙高度及腰椎前凸角无明显变化（P＞0.05），相应时间点，两组间影像指标的差异均无统计学意义（P＞0.05)。[结论] 两种术式治疗腰椎间盘突出症的疗效相当，相比之下，PTED 虽然手术时间长，术中透视次数多，但创伤更小，患者能够早期下地活动，恢复更快。

Abstract:

[Objective] To compare percutaneous transforaminal endoscopic discectomy (PTED) versus quadrant channel discectomy(QCD) in the treatment of lumbar disc herniation. [Methods] A retrospective study was conducted on 78 patients who had single-level discherniation removed surgically in our department in 2022. According to preoperative doctor-patient communication, 40 patients were treatedwith PTED, while other 38 patients were treated with QCD. The perioperative, follow-up and imaging data of the two groups were com-pared. [Results] All patients in both groups had corresponding operations performed successfully without serious complications. Althoughthe PTED was significantly greater than the QCD group in terms of operative time [(65.7±6.4) min vs (34.2±6.7) min, P=0.027] and the expo-sure number of fluoroscopy [(6.8±1.0) times vs (2.4±1.0) times, P=0.004], the former was significantly less than the latter regarding to inci-sion length [(0.8±0.2) cm vs (2.3±0.2) cm, P＜0.001], intraoperative blood loss [(31.6±10.2) ml vs (54.8±11.4) ml, P=0.004] and postopera-tive bed rest time [(2.0±0.6) days vs (3.5±0.5) days, P＜0.001]. As time went by, the VAS scores of low back pain and leg pain, as well asODI score in both groups were significantly decreased (P＜0.05), whereas which were not statistically significant between the two groups atany time points accordingly (P＞0.05). As for imaging, the spinal canal occupying rate significantly reduced (P＜0.05), while the interverte-bral height and lumbar lordotic angle remained unchanged significantly in both groups after operation compared with those preoperatively(P＞0.05). At any corresponding time points, there were no statistically significant differences in imaging indicators between the two groups(P＞0.05). [Conclusion] The clinical consequence of the two techniques on lumbar disc herniation is comparable. By comparison, the PT-ED, despite of taking longer operation time and more intraoperative fluoroscopy times, has considerately less trauma, which facilitates earli-er ambulation and faster recovery over the QCD.