目的 探讨经皮内镜椎间孔入路椎间盘切除术 ( transforaminal percutaneous endoscopic lumbar discectomy,TF-PELD ) 治疗腰椎间盘突出症 ( lumbar disc heniation,LDH ) 的临床效果及安全性.方法 回顾性分析 2016 年 1 月至 2017 年 2 月,我院收治的 70 例 LDH 患者的临床资料,其中 34 例采用 TF-PELD 治疗( 观察组 ),36 例采用开放性手术 ( 对照组 ),术后随访 6 个月,随访率 100%,评价并分析两组手术指标和治疗效果.结果 观察组手术时间长于对照组 [ ( 65.3±7.2 ) min vs. ( 58.4±6.4 ) min ],但出血量 [ ( 47.3± 8.5)ml vs.(142.4±12.3)ml]、下床活动时间[(1.6±0.5)天vs.(13.4±2.4)天]和住院时间[(4.9±1.5)天vs. ( 16.2±3.9 ) 天 ] 均少于对照组,差异有统计学意义 ( P<0.05 ).两组患者术后 3 个月和 6 个月时的疼痛视觉模拟评分 ( visual analogue scale,VAS ) 和 Oswestry 功能障碍指数 ( oswestry disability index,ODI ) 评分均显著低于术前,差异有统计学意义(P<0.05);观察组术后3个月(2.41±0.82 vs.4.34±0.93)和术后6个月(1.61±0.56 vs.2.17±0.78)的VAS显著低于对照组,差异有统计学意义(P<0.05);观察组术后3个月(23.27±7.79 vs. 35.47±8.24 ) 和术后 6 个月 ( 14.45±3.47 vs. 18.66±5.18 ) 的 ODI 评分显著低于对照组,差异有统计学意义( P<0.05 ).观察组和对照组 MacNab 疗效优良率分别为 91.18% 和 69.44%,差异有统计学意义 ( P<0.05 ).结论 TF-PELD 治疗 LDH 安全有效、术后恢复快、并发症少,值得临床推广.%Objective To investigate the clinical effects and safety of transforaminal percutaneous endoscopic lumbar discectomy ( TF-PELD ) in the treatment of lumbar disc heniation ( LDH ). Methods The clinical data of 70 patients with LDH, admitted from January 2016 to February 2017, were analyzed retrospectively. Among them, 34 patients were treated with TF-PELD ( observation group ) and 36 patients were treated with open surgery ( control group ). After a follow-up of 6 months, the follow-up rate was 100%. The surgical indexes and treatment effects were evaluated and analyzed. Results The operative time of the observation group was significantly longer than that of the control group[(65.3 ± 7.2)min vs.(58.4 ± 6.4)min](P<0.05).The amount of bleeding[(47.3 ± 8.5)ml vs. ( 142.4 ± 12.3 ) ml ] was significantly less than those in the control group ( P < 0.05 ). The time for getting out of bed [(1.6 ± 0.5)d vs.(13.4 ± 2.4)d]and hospital stay[(4.9 ± 1.5)d vs.(16.2 ± 3.9)d]were significantly shorter than those in the control group ( P < 0.05 ). The VAS and ODI scores 3 months and 6 months after operation in both groups were significantly lower than those before operation with statistically significance ( P < 0.05 ). The VAS scores in the observation group 3 months after operation(2.41 ± 0.82 vs.4.34 ± 0.93)and 6 months after operation(1.61 ± 0.56 vs. 2.17 ± 0.78 ) were significantly lower than those in the control group with statistical significance ( P < 0.05 ). The ODI scores of observation group 3 months after operation(23.27 ± 7.79 vs. 35.47 ± 8.24)and 6 months after operation ( 14.45 ± 3.47 vs. 18.66 ± 5.18 ) were significantly lower than those in control group with statistical significance ( P < 0.05 ). The excellent and good rates of MacNab in observation group and control group were 91.18% and 69.44% respectively. The differences were statistically significant ( P < 0.05 ). Conclusions TF-PELD is safe and effective with quick recovery. It causes less complications in the treatment of LDH.
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