关键词: 内窥镜, 椎间孔入路, 椎板间入路, 腰椎间盘突出症

Abstract:

Objective To compare the efficacy of percutaneous transforaminal approach and translaminar approach in the treatment of L₅/S₁ disc herniation （LDH） under endoscopic discectomy. Methods Adopted a retrospective case-control study， and selected 62 cases of patients with L₅/S₁ LDH who were treated with percutaneous endoscopic surgery in the spine surgery department of our hospital from June 2020 to December 2022， and the transforaminal approach was used. （TELD） in 32 cases （TELD group）， and interlaminar approach （IELD） in 30 cases （IELD group）. The observation indicators included intraoperative fluoroscopy times， operation time， hospitalization days， hospitalization expenses， leg pain VAS score， ODI score， modified MacNab curative effect evaluation and complications. Results All 62 patients successfully completed the operation and follow-up， and no serious complications occurred. There were statistically significant differences in operation time， fluoroscopy times， and hospitalization expenses between the two groups （P < 0.001）， but there was no significant difference in hospitalization days between the two groups （P > 0.05）. The lower extremity VAS scores at the last follow-up and the last follow-up were significantly improved compared with those before operation （P < 0.001）， and the ODI scores of the two groups were significantly improved at 2 days， 1 month and at the last follow-up （P < 0.001）. At the same time point， there was no statistical difference （P > 0.05）； there was no significant difference in the excellent and good rate of surgery between the two groups （P > 0.05）. 11 patients with high iliac crest in the TELD group successfully completed the surgery. Conclusions Both the endoscopic surgery through the intervertebral foramen and the interlaminar approach can achieve satisfactory results in the treatment of L₅/S₁ LDH. However， local anesthesia through the intervertebral foramen approach reduces hospitalization costs， and patients with high iliac crest can successfully complete the surgery by selecting a suitable puncture path. The translaminar approach has fewer fluoroscopy times and shorter surgical time， but there is a higher risk of dura mater and nerve damage， which requires careful operation for beginners.

Key words: endoscopy, intervertebral foramen approach, intervertebral approach, lumbar disc herniation