经皮内窥镜下两种入路治疗腰5/骶1椎间盘突出症对比研究

doi:10.3969/j.issn.1006-5725.2024.06.013

Abstract

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

CLC Number:

R681.5⁺7

Zhiwei SHI,Jianming WU,Yahui NIU,Chen GONG. Comparative study of percutaneous endoscopic treatment of L₅/S₁ disc herniation by two approaches[J]. The Journal of Practical Medicine, 2024, 40(6): 807-813.

Figures/Tables 6

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References 24

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组别	透视次数（次）	手术时间（min）	住院时间（d）	住院费用（元）
TELD组	16.3 ± 2.9	72.8 ± 6.1	4.8 ± 0.7	11 768.1 ± 494.2
IELD组	6.2 ± 1.1	53.6 ± 3.4	4.5 ± 0.8	13 801.1 ± 333.1
t值	8.226	9.652	0.862	-18.866
P值	< 0.001	< 0.001	0.401	< 0.001

组别	术前	术后2 d	术后1个月	末次随访	F值	P值
TELD组	7.2 ± 0.6	2.1 ± 0.8	1.4 ± 0.5	1.1 ± 0.3	26.385	< 0.001
IELD组	7.3 ± 0.5	2.0 ± 0.6	1.5 ± 0.7	1.2 ± 0.4	31.524	< 0.001
t值	0.855	0.725	0.813	0.967
P值	0.431	0.437	0.452	0.422

组别	术前	术后2 d	术后1个月	末次随访	F值	P值
TELD组	63.88 ± 5.81	20.39 ± 3.25	16.24 ± 1.23	15.58 ± 1.38	35.981	< 0.001
IELD组	64.32 ± 5.20	19.89 ± 3.57	16.55 ± 1.84	15.64 ± 1.64	40.362	< 0.001
t值	0.844	0.886	0.651	0.636
P值	0.452	0.448	0.598	0.601

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Comparative study of percutaneous endoscopic treatment of L₅/S₁ disc herniation by two approaches

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Comparative study of percutaneous endoscopic treatment of L5/S1 disc herniation by two approaches

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Comparative study of percutaneous endoscopic treatment of L₅/S₁ disc herniation by two approaches