摘要目的 比较经皮椎间孔镜下椎间盘切除术(PTED)和后外侧经椎间孔椎间盘切除融合术(TLIF)治疗高位腰椎间盘突出症的效果.方法 回顾性分析2010年2月至2015年2月收治的高位腰椎间盘突出症患者,根据标准共纳入63例,其中采用PTED治疗33例(PTED组),采用TLIF治疗30例(TLIF组).通过视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)评价两组患者手术前后的改善情况,并比较两组的手术时间、术中出出血量、术后48 h引流量、住院时间、透视次数、并发症、复发率以及术后恢复情况.随访时间为12 ～ 33个月.结果 PTED组的手术时间、术r中出血量、术后48 h引流量、住院时间均显著小于TLIF组[(71±19)比(121 ±22) min]、(30±21)比(317±50)ml、0比(93±29)ml、(3.5±1.9)比(12.5±2.1)d],而PTED组的透视次数显著高于TLIF组[(16.2±8.3)比(6.7±4.2)次](均P ＜0.05).两组间术后VAS评分和ODI改善率差异均无统计学意义(均P＞0.05).两组手术优良率、复发率差异均无统计-学意义(均P＞0.05).结论 PTED治疗高位腰椎间盘突出症,与TLIF相比具有创伤小、出血少以及术后恢复快的特点,疗效、复发率与TLIF相近,是治疗高位腰椎间盘突出症的有效方法.

abstractsObjective To compare the efficacy of percutaneous endoscopic transforaminal discectomy (PTED) and transforaminal lumbar interbody fusion (TLIF) in the treatment of high lumbar disc herniation.Methods The clinical data of patients with high lumbar disc herniation from February 2010 to February 2015 were retrospective analyzed.According to the inclusion criteria,a total of 63 cases were enrolled,including PTED group 33 cases,TLIF group 30 cases.The improvement of the two groups before and after surgery was assessed by visual analogue scale (VAS) and Oswestry dysfunction index (ODI).The operative time,intraoperative blood loss,drainage volume at 48 h postoperatively,hospitalization time,number of fluoroscopy,complication,recurrence rate and postoperative recovery were compared between the two groups.The follow-up period was 12 to 33 months.Results The operation time,intraoperative blood loss,drainage amount and hospitalization time in PTED group were significantly less than those in TLIF group[(71±19) vs (121±22) min,(30±21) vs (317±50) ml,0 vs (93±29) ml,(3.5±1.9) vs (12.5 ± 2.1) d].The number of fluoroscopy in PTED group was significantly higher than TLIF group [(16.2 ± 8.3) vs (6.7 ± 4.2)] (all P ＜ 0.05).There was no significant difference in VAS score and ODI improvemnent rate between the two groups after operation (both P ＞ 0.05).There was no significant difference between the two groups in the excellent rate of surgery and the recurrence rate (both P ＞ 0.05).Conclusions PTED has the advantages uf less trauma and bleeding,rapid postoperative recovery in the treatment of upper lumbar disc herniation compared with TLIF,and the curative effect and recurrence rate are similar with TLIF.Therefore,PTED is an effective method for the treatment of upper lumbar disc herniation.