摘要：
Objective To investigate the effect of microendoscopy discectomy( MED) and percu-taneous transforaminal endoscopic discectomy(PTED) on the treatment of patients with lumbar disc hernia-tion and its complications. Methods A retrospective study was performed on a total of 112 patients with lumbar disc herniation admitted from June 2017 to December 2018. According to different surgical methods, the patients were divided into the MED group and the PTED group,with 56 cases in each group. In the MED group,36 males and 20 females were aged(56. 34 ± 5. 23) years old,ranging from 24 to 78 years old. In the PTED group,37 males and 19 females were aged(56. 88 ± 5. 22) years old,ranging from 25 to 79 years old. Compare two groups of surgery,surgery in patients with preoperative and postoperative 7 days,1 month, 2 months after operation,postoperative 3 months after two groups of patients with the Japanese orthopaedic association assessment score( JOA) treatment,postoperative complications,preoperative and postoperative 7 days two groups of patients with visual analogue score (VAS),3 months,6 months after disease recur-rence. Results The operative time[(61. 24 ± 4. 23) min] of the PTED group was longer than that of the MED group[(54. 53 ± 3. 16) min],the operative incision length[(7. 20 ± 0. 20) mm] of the PTED group was shorter than that of the MED group[(18. 45 ± 2. 45) mm],the intraoperative blood loss[(25. 34 ± 4. 35) ml] of the PTED group was lower than that of the MED group[(87. 45 ± 4. 53) ml],and the post-operative field activity time[(3. 45 ± 0. 41) d] of the PTED group was shorter than that of the MED group [(7. 12 ± 0. 34) d],and the differences were statistically significant(P0. 05). There was no significant difference in JOA scores between the two groups before and 7 days after surgery,1 month after surgery, 2 months after surgery and 3 months after surgery(P>0. 05). Comparison of VAS scores between the two groups before operation showed no statistically significant difference(P>0. 05). Postoperative VAS score of 7 days in PTED group(2. 54 ± 0. 18) was better than that of MED group(3. 45 ± 0. 24),and the difference was statistically significant(P0. 05). There was no statistically significant differ-ence in disease recurrence rate between the two groups 3 months and 6 months after surgery( P>0. 05). Conclusion MED and PTED in treatment of lumbar intervertebral disc protrusion has significant clinical effect,MED has a shorter time than PTED,PTED has less trauma,pain,patients recover quickly,two kinds of surgical complications and recurrence rates are low,high security,PTED better application effect in pa-tients with lumbar disc prolapse,more widely,clinical ability according to patients condition,leading doctors surgery,hospital medical level choose the surgical methods and instruments.%目的 探究椎间盘镜手术(MED)与椎间孔镜手术( PTED)对腰椎间盘突出症患者治疗效果及并发症影响.方法 选取2017年6月至2018年12月晋中市第四人民医院脊柱外科收治的112例腰椎间盘突出症患者.根据手术方法不同将患者分为 MED组与 PTED组,每组56 例.MED组男36例,女20例,年龄(56. 34 ± 5. 23)岁,年龄范围为24~78岁;PTED组男37例,女19例,年龄(56. 88 ± 5. 22)岁,年龄范围为25~79岁.比较两组患者手术情况、手术效果与术前、术后7 d、术后1个月、术后2个月、术后3个月两组患者日本骨科协会评估治疗分数(JOA)、术后并发症情况、术前及术后7 d两组患者视觉模拟疼痛评分法( VAS)、术后3个月、6个月疾病复发率的情况.结果 PTED组患者手术时间[(61. 24 ± 4. 23) min]长于MED组[(54. 53 ± 3. 16)min],PTED组患者手术切口长度[(7. 20 ± 0. 20) mm]短于 MED 组[(18. 45 ± 2. 45) mm], PTED 组术中出血量[(25. 34 ± 4. 35) ml]少于 MED 组[( 87. 45 ± 4. 53 ) ml], PTED 组术后下地活动时间[( 3. 45 ± 0. 41)d]短于MED组[(7. 12 ± 0. 34)d],差异均有统计学意义(P0. 05);术前、术后7 d、术后1个月、术后2个月、术后3个月两组患者JOA评分比较,差异均无统计学意义(P>0. 05).术前两组患者VAS评分比较,差异无统计学意义( P >0. 05 );术后 7 d PTED 组 VAS 评分[( 2. 54 ± 0. 18 )分]优于 MED 组[( 3. 45 ± 0. 24)分],差异有统计学意义(P0. 05).术后3 个月、6 个月两组患者疾病复发率比较,差异无统计学意义(P>0. 05).结论 MED与PTED治疗腰椎间盘突出症均有显著的临床效果,MED时间相对PTED更短,PTED创伤更小,疼痛轻,患者恢复更快,两种手术并发症发生率及复发率均较低,安全性较高, PTED在腰椎间盘突出症患者中应用效果更佳,应用更为广泛,临床可根据患者情况、主刀医师手术能力、医院医疗水平及器械等情况合理选择手术方法.
