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| Comparative Analysis of two Different Surgical Approaches for the treatment of Lumbar Disc Herniation by Foramen Endoscopy |
| ZHOU Xin, HAN Jianhua, YAN Jiaqiang |
| The Third Affiliated Hospital of Zunyi Medical University, Guizhou Province / Zunyi First People's Hospital, Guizhou Zunyi 563000, China |
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Abstract Objective: To compare the curative effect and safety of foraminal endoscope on lumbar disc herniation (LDH) through two different surgical approaches. Methods: The clinical data of 157 patients with LDH who were admitted to the hospital from March 2015 to October 2018 were analyzed retrospectively. The patients were divided into foraminal group (foraminal endoscope through foraminal approach surgery, n=76) and laminar group (foraminal endoscope through laminar space approach surgery, n=81) according to different treatment methods. The general surgical conditions, surgical effects, score of visual analogue pain scale (VAS), fear visual analogue scale (FAVS), Oswestry dysfunction index (ODI), incidence of complication and recurrence rate were compared between the two groups. Results: There was no significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). The leaving bed time in foraminal group was significantly shorter than that in laminar group, while treatment cost was significantly lower than that in laminar group (P<0.05). There was no significant different in postoperative total good rate between the two groups (P>0.05). VAS score and ODI score of both groups were significantly decreased after surgery. The intraoperative VAS score in foraminal group was significantly higher than that in laminar group, and preoperative FAVS was significantly higher than that in laminar group (P<0.05). There was no significant difference in VAS score or ODI score between the two groups (P>0.05). There was no significant difference in total incidence of complications or recurrence rate between the two groups (P>0.05). The incidence of tissue damage in the posterior spine in laminar group was significantly higher than that in foraminal group (P<0.05). Conclusion: The effects of the two surgical approaches are comparable in terms of clinical curative effect, reducing postoperative pain and function improvement for LDH patients. However, laminar approach can more significantly reduce intraoperative pain and preoperative fear, suitable for patients with L5S1 segment and high ilium cliff. And foraminal approach surgery is suitable for patients who cannot tolerate general anesthesia.
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[1] 袁娜,张威.中药联合拔罐治疗血瘀气滞型腰椎间盘突出症的临床疗效及影响因素分析[J].河北医学,2017,23(8):1366~1368.
[2] 格日勒.经皮椎间孔镜技术治疗腰椎间盘突出症的应用进展[J].中国微创外科杂志,2018,18(3):267~270,273.
[3] 吴祖耀,刘建华,杨国良,等.腰-(4/5)节段椎间孔镜经不同手术入路的应用解剖[J].解剖学研究,2016,16(5):56~59.
[4] 刘延青.腰椎间盘突出症诊断和治疗现状(上)[J].中国疼痛医学杂志,2006,21(2):21.
[5] 何丁文,姚玉龙,邓中博,等.经皮椎间孔镜技术翻修腰椎融合术后椎间隙感染[J].中国矫形外科杂志,2017,25(11):1042~1044.
[6] 伊立,董志坚,王锁良,等.经皮椎间孔镜两种手术入路治疗钙化型腰椎间盘突出症的疗效比较[J].中国疼痛医学杂志,2017,23(4):277~282.
[7] 马敬寿,王晓波,刘福志,等.经椎板间入路椎间孔镜治疗下段腰椎间盘突出症[J].中华创伤骨科杂志,2016,18(3):261~264. |
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2019, Vol. 25 
