CAJ | 학술논문

目的：比较经皮椎间孔镜髓核摘除术（ PELD）和经椎间孔入路腰椎体间融合术（ TLIF）治疗腰椎间盘突出症并神经根管狭窄的临床疗效。方法根据治疗方法不同将38例腰椎间盘突出症并神经根管狭窄患者分为2组：17例行PELD术治疗者作为PELD组，21例行TLIF术治疗者作为TLIF组，2组均随访12个月。比较2组手术完成情况，术中及术后并发症发生情况，治疗前后VAS评分、ODI评分变化，随访12个月手术疗效。结果 PELD组手术切口小于TLIF组（P＜0．05），手术时间、住院时间均短于TLIF组（P均＜0．05）。2组并发症发生率比较差异无统计学意义。 PELD组术后1 d VAS评分明显低于TLIF组（ P＜0．05），2组术后1，6，12个月VAS评分比较差异无统计学意义。2组术后12个月ODI评分及改良Macnab疗效评价优良率比较差异均无统计学意义。结论 PELD与TLIF均是治疗腰椎间盘突出症并神经根管狭窄的有效手段。尽管前者学习曲线更陡峭，但其相对于后者更具微创性，对邻近节段的影响更小。
목적：비교경피추간공경수핵적제술（ PELD）화경추간공입로요추체간융합술（ TLIF）치료요추간반돌출증병신경근관협착적림상료효。방법근거치료방법불동장38례요추간반돌출증병신경근관협착환자분위2조：17례행PELD술치료자작위PELD조，21례행TLIF술치료자작위TLIF조，2조균수방12개월。비교2조수술완성정황，술중급술후병발증발생정황，치료전후VAS평분、ODI평분변화，수방12개월수술료효。결과 PELD조수술절구소우TLIF조（P＜0．05），수술시간、주원시간균단우TLIF조（P균＜0．05）。2조병발증발생솔비교차이무통계학의의。 PELD조술후1 d VAS평분명현저우TLIF조（ P＜0．05），2조술후1，6，12개월VAS평분비교차이무통계학의의。2조술후12개월ODI평분급개량Macnab료효평개우량솔비교차이균무통계학의의。결론 PELD여TLIF균시치료요추간반돌출증병신경근관협착적유효수단。진관전자학습곡선경두초，단기상대우후자경구미창성，대린근절단적영향경소。
Objective It is to compare the clinical effects between the percutaneous endoscopic lumbar discectomy (PELD) and transforaminal lumbar interbody fusion(TLIF) in the treatment of lumbar disc herniation and nerve root canal stenosis .Methods 38 patients with lumbar disc herniation and nerve root canal stenosis were divided into two groups according to their treatment method:17 cases treated with PELD as PELD group, and other 21 patients received TLIF as TLIF group, both the two groups were followed up for 12 months.The operation finishing, occurrence of complications during and after sur-gery, the changes of visual analogue scale(VAS) and Oswestry disability index(ODI) before and after the operation were com-pared between the two groups.Results The cut area of PELD group was smaller while operation time and hospitalizaion time were shorter than that of TLIF group (P all<0.05).There was no significant difference in the occurrence rate of complication between the two groups.The VAS scores in one day after operation was lower in PELD group than that in TLIF group (P<0. 05), but the differences were not significant in 1, 6, 12 months between the two groups.There was no significant difference in ODI scores and good rate evaluated by modified Macnab criteria in 12 months after operation between the two groups.Conclu-sion Both PELD and TLIF are the effective methods of treatment for lumbar disc herniation and nerve root canal stenosis.Rela-tive to the TLIF ,although the former's learning curve is more steepen, it shows advantages in representing more minimally in-vasive, lowering health care costs and influencing less on adjacent segment.