Objective To compare the clinical outcome between percutaneous transforaminal endoscopic discectomy and intervertebral fenestration for the treatment of double-segmental lumbar disc herniation. Methods 100 patients with primary lumbar disc herniation were divided into transforaminal endoscope group ( 50 cases ) and fenestration group(50 cases). The patients of transforaminal endoscope group underwent percutaneous transforaminal endoscope discectomy under local anesthesia,the patients of fenestration group were treated with intervertebral fenestration and removal of nucleus pulposus operation under peridural anesthesia by posterior approach. The operation time,the data of VAS and ODI before and after operation were compared between the two groups, the effects was evaluated accord-ing to Chinese Orthopaedic Association criteria. Results The follow-up time was 12~16 months. The operation time and each item score of two groups showed no significant difference by comparing with the preoperation ( P>0. 05 ) , both VAS of leg pain and ODI of each group was decreased obviously than the preoperative(P<0. 05). Within 1~14 days of postoperation, transforaminal endoscope group was significantly lower than fenestration group about the VAS of lumbar pain (P<0. 05). 3~12 months postoperation, there was no difference in the two groups of lumbar pain VAS (P>0. 05). No significant difference could be observed on ODI for 1~12 months postoperatively in two groups(P>0. 05). At the latest follow-up, the excellent and good rate was 92% in transforaminal endoscope group and 94% in fenestration group( P >0. 05 ) . Conclusions Two surgical techniques are effectively for the patient′s symptoms caused by nerve root compression, but the percutaneous transforaminal endoscopic discectomy has advantages of mini-mal invasion. It is a better method in the treatment of double-segmental lumbar disc herniation.%目的 比较椎间孔镜技术与椎板间开窗治疗双节段腰椎间盘突出症的疗效. 方法 将100例初次腰椎间盘突出症患者分为椎间孔镜组(50例)和开窗组(50例). 椎间孔镜组在局部麻醉下行经皮椎间孔镜髓核摘除手术,开窗组在硬膜外麻醉下行后路椎板间开窗髓核摘除手术. 比较两组手术时间、手术前后腰、腿痛VAS评分及ODI评分,并根据中华医学会骨科分会脊柱学组手术疗效标准进行疗效评估. 结果 两组患者均获得随访,时间12~16个月. 两组术前各项评分及手术时间比较差异均无统计学意义( P>0. 05 ). 术后两组腿痛VAS及ODI评分均较术前降低(P<0. 05). 术后1~14 d腰痛VAS评分椎间孔镜组远低于开窗组(P<0. 05),术后3~12个月两组腰痛VAS评分比较差异无统计学意义(P>0. 05). 术后1 ~12 个月两组ODI评分比较差异无统计学意义( P>0. 05 ). 末次随访时优良率:椎间孔镜组为92%,开窗组为94%( P>0. 05). 结论 两种手术均可有效治疗患者神经根压迫造成的症状,但经皮椎间孔镜髓核摘除手术创伤小,是治疗腰椎间盘突出症更为理想的方法.
展开▼
