经皮椎板间入路与经皮椎间孔入路内窥镜下椎间盘切除术治疗L4/5椎间盘突出症患者的价值对比

刘志坚

[摘要] 目的 对比经皮椎板间入路与经皮椎间孔入路内窥镜下椎间盘切除术治疗L4/5椎间盘突出症患者的临床价值。方法 方便选取2016年5月—2019年4月在该院接受经皮脊柱内镜椎间盘髓核摘除术治疗的L4/5椎间盘突出症患者，共有80例，其中经椎板间入路为20例，椎间孔入路60例，采用经皮椎板间入路作为A组（n=20），随机抽取经椎间孔入路20例，作为B组（n=20），比较两组治疗效果。结果A组治疗优良率为95.00%，B组为90.00%，组间差异无统计学意义（χ2=0.360，P=0.548>0.05）。结论 经皮椎板间入路与经皮椎间孔入路内窥镜下椎间盘切除术在治疗L4/5椎间盘突出症疾病中疗效相当，均可明显改善患者病情，并发症相似，但适应症不同，椎间孔入路是经典，椎板间入路是必要的补充。

[关键词] 经皮椎板间入路;经皮椎间孔入路;内窥镜下椎间盘切除术;椎间盘突出症

[中图分类号] R687.3          [文献标识码] A          [文章编号] 1674-0742（2020）01（c）-0078-03

Comparison of the Value of Percutaneous Transluminal Approach and Percutaneous Transforaminal Lumbar Discectomy for Patients with L4/5 Disc Herniation

LIU Zhi-jian

Department of Orthopedics， Integrated Traditional Chinese and Western Medicine Hospital，Yixing，Jiangsu Province， 214200 China

[Abstract] Objective To compare the clinical value of percutaneous lumbar intervertebral approach and percutaneous transforaminal lumbar discectomy for patients with L4/5 disc herniation. Methods Convenient selected a total of 80 patients with L4/5 intervertebral disc herniation who underwent percutaneous spinal nucleus pulposus removal in the hospital from May 2016 to April 2019 were enrolled， including 20 patients undergoing transsacral approach. 60 cases of intervertebral foramen approach， using percutaneous interlaminar approach as group A （n=20）， randomized transforaminal approach in 20 cases， as group B （n=20）， comparing the two groups of treatment effect. Results The excellent and good rate of treatment in group A was 95.00%， and that in group B was 90.00%. There was no statistically significant difference between the groups （χ2=0.360， P=0.548>0.05）. Conclusion Endoscopic intervertebral approach and percutaneous transforaminal discectomy are effective in the treatment of L4/5 disc herniation， which can significantly improve the patient's condition， but the complications are similar， but adapted Different from the disease， the intervertebral foramen approach is a classic， and the interlaminar approach is a necessary supplement.

[Key words] Transcutaneous intervertebral approach; Percutaneous intervertebral foramen approach; Endoscopic discectomy; Disc herniation

經皮脊柱内镜腰椎间盘切除术一般认为有两种入路，即经椎间孔入路和经椎板间入路。椎间孔入路是经典入路，能处理绝大多数类型腰椎间盘突出症，在临床上取得了公认疗效[1]。椎板间入路在腰5骶1椎间盘突出症髓核摘除术上同样取得较好疗效，被作为高髂棘、横突肥大者、高度向下脱垂腰5骶1椎间盘突出症髓核摘除术重要补充手段。但经椎板间入路在腰4/5椎间盘突出症髓核摘除术上的疗效、并发症如何以及有无应用价值、适应症等仍未获得明确结果[2]。该文方便选取2016年5月—2019年4月在该院接受经皮脊柱内镜椎间盘髓核摘除术治疗的L4/5椎间盘突出症患者，共有80例，对比经皮椎板间入路与经皮椎间孔入路内窥镜下椎间盘切除术治疗L4/5椎间盘突出症患者的疗效和并发症、临床价值，现报道如下。