经皮椎间孔镜与经侧隐窝入路胶原酶髓核溶解术治疗腰椎间盘突出症的效果对比研究

摘要

目的:比较经皮椎间孔镜与经侧隐窝入路胶原酶髓核溶解术治疗腰椎间盘突出症的效果.方法:选取84例腰椎间盘突出症患者,按照随机数表法将其分为经皮椎间孔镜组及髓核溶解术组,每组42例.经皮椎间孔镜组采用经皮椎间孔镜行腰间盘切除术,髓核溶解术组行经侧隐窝入路胶原酶髓核溶解术,比较两组患者视觉模拟(VAS)评分和治疗优良率;分析两组典型病例磁共振成像(MRI)影像表现.结果:两组经不同方法治疗后,VAS评分均呈现下降趋势,但经皮椎间孔镜组VAS评分下降幅度在术后3 d、1个月、3个月和6个月各时间点均大于髓核溶解术组,两组比较差异具有统计学意义(t=7.17,t=6.67,t=4.68,t=2.06;P＜0.05).术后3 d及术后1个月经皮椎间孔镜组治疗优良率均高于髓核溶解术组,差异具有统计学意义(x2=6.87,x2=4.94;P＜0.05);两组术后3个月及术后6个月治疗优良率差异无统计学意义.结论:经皮椎间孔镜与经侧隐窝入路胶原酶髓核溶解术治疗腰椎间盘突出症均具有较好的临床治疗效果,有助于缓解疼痛,改善生活质量,但经皮椎间孔镜腰椎间盘切除术短期内效果更优.%Objective: To compare the effects of two curative methods that were percutaneous transforaminal endoscopic discectomy(PTED)and chemonucleolysis of collagenase by lateral recess in treating lumbar disc herniation.Methods: 84 patients with lumbar disc herniation were selected and were randomly divided into PTED group(42 cases)and chemoonucleolysis group(42 cases)according to random number table method.Patients of PTED group received treatment of PTED and those of chemonucleolysis group received treatment of chemonucleolysis of collagenase by lateral recess.And then the visual analogue scale(VAS)and the excellent and good rate of treatment effects of the two groups were compared,and the imaging performance of MRI of typical cases of the two groups were analyzed.Results: After patients of two groups were treated,the VAS scores of two groups appeared downtrend,while the descend ranges of VAS scores of PTED group at postoperative 3d,1 month,3 months and 6 months were significantly bigger than those of chemoonucleolysis group(t=7.17,t=6.67,t=4.68,t=2.06,P＜0.05),respectively.Besides,the excellent and good rate of treatment of PTED group at postoperative 3d and 1 month were significantly higher than that of chemoonucleolysis group(x2=6.87,x2=4.94,P＜0.05),repectively.While the differences of excellent and good rate of treatment of the two groups at postoperative 3 months and 6 months were no significant.Conclusion:Both of PTED and chemonucleolysis of collagenase by lateral recess have better clinically curative effect,and they can relieve pain and improve life quality.While in short term,PTED can achieve more better effects.