經皮椎板間入路與經皮椎間孔入路內窺鏡下椎間盤切除術治療L4/5椎間盤突出癥患者的價值對比

劉志堅

[摘要] 目的 對比經皮椎板間入路與經皮椎間孔入路內窺鏡下椎間盤切除術治療L4/5椎間盤突出癥患者的臨床價值。方法 方便選取2016年5月—2019年4月在該院接受經皮脊柱內鏡椎間盤髓核摘除術治療的L4/5椎間盤突出癥患者，共有80例，其中經椎板間入路為20例，椎間孔入路60例，采用經皮椎板間入路作為A組（n=20），隨機抽取經椎間孔入路20例，作為B組（n=20），比較兩組治療效果。結果A組治療優良率為95.00%，B組為90.00%，組間差異無統計學意義（χ2=0.360，P=0.548>0.05）。結論 經皮椎板間入路與經皮椎間孔入路內窺鏡下椎間盤切除術在治療L4/5椎間盤突出癥疾病中療效相當，均可明顯改善患者病情，并發癥相似，但適應癥不同，椎間孔入路是經典，椎板間入路是必要的補充。

[關鍵詞] 經皮椎板間入路;經皮椎間孔入路;內窺鏡下椎間盤切除術;椎間盤突出癥

[中圖分類號] R687.3 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 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

經皮脊柱內鏡腰椎間盤切除術一般認為有兩種入路，即經椎間孔入路和經椎板間入路。椎間孔入路是經典入路，能處理絕大多數類型腰椎間盤突出癥，在臨床上取得了公認療效[1]。椎板間入路在腰5骶1椎間盤突出癥髓核摘除術上同樣取得較好療效，被作為高髂棘、橫突肥大者、高度向下脫垂腰5骶1椎間盤突出癥髓核摘除術重要補充手段。但經椎板間入路在腰4/5椎間盤突出癥髓核摘除術上的療效、并發癥如何以及有無應用價值、適應癥等仍未獲得明確結果[2]。該文方便選取2016年5月—2019年4月在該院接受經皮脊柱內鏡椎間盤髓核摘除術治療的L4/5椎間盤突出癥患者，共有80例，對比經皮椎板間入路與經皮椎間孔入路內窺鏡下椎間盤切除術治療L4/5椎間盤突出癥患者的療效和并發癥、臨床價值，現報道如下。