| Purpose:Lumbar disc herniation(LDH)is a common disease in spine surgery and is one of the major causes of low back pain and leg pain.Recurrent pain not only causes great harm to the patient’s body and mind,but also brings heavy burden to the society and family.For the past few years,minimally invasive spine surgery has flourished in the field of spinal surgery,and it is considered the mainstay of therapy for lumbar disc herniation,which has received more and more attention.The aims of this project were to compare the clinical efficacy of the Delta endoscopic nucleus pulposus resection with classical interlaminar fenestration discectomy in the treatment of lumbar disc herniation.Methods:Add up to 201 patients with lumbar disc herniation to the Spinal Surgery Department of Qilu Hospital of Shandong University from January 2019 to March 2021 and received Delta endoscopic technique and traditional fenestration discectomy were enrolled in this study.The patients were divided into two groups based on the type of surgery,102 patients received the Delta endoscopic nucleus pulposus resection.99 patients underwent interlaminar fenestration discectomy.By consulting the patient’s case data and follow-up data.The patient’s gender,age,body mass index(BMI),operative and responsible intervertebral disc Pfirrmann grading,presence of Modic in cartilage endplate,presence of lumbosacral transitional vertebrae(LSTV),personal history,past history,amount of blood loss during surgery,duration of surgery,length of hospital stay,duration of postoperative bed-to-bed activity,and operation were analyzed Posterior incision VAS score and Oswestry disability index.Baseline data were matched using a 1:1 propensity score matching(PSM)method to reduce the impact of data bias and confounding variables,and the clinical outcomes of the two surgical procedures were compared by retrospective analysis of matched patient data.Results:Partial baseline data of patients in the two surgical groups before propensity score matching were not statistically significant,such as previous history(heart disease,diabetes,hypertension,P=0.9800,0.9700,1.0000),patients’ BMI(P=0.1800),imaging indicators(LSTV,Pfirrmann grade,end-plate degeneration,P=0.2800,0.0500,1.0000).Other baseline data such as gender,age,personal history and surgical level were statistically significant(P<0.05).After PSM treatment,52 cases were matched successfully in both the Delta endoscopic surgery group and the traditional fenestration discectomy surgery group,and there was no statistical significance in each baseline data before surgery between the two surgery groups(P>0.05).In Delta endoscopic surgery group,the amount of blood lost during surgery was 18.17±4.20ml,the postoperative hospital days was 4.16 ± 2.29 days,and the postoperative bed out time was 1.58±0.88 days,while in fenestration discectomy surgery group the amount of blood lost during surgery was 32.50±17.13ml,the postoperative hospital days was 6.66±2.44 days,the postoperative bed out time was 3.18± 1.28 days.The difference between the two groups was statistically significant(P<0.05).However,in terms of operation time,the Delta endoscopic surgery group was 88.90± 19.14min,while the traditional fenestration discectomy surgery group was 67.63± 19.32min,and the difference between the two surgery groups were statistically significant(P<0.05).In terms of VAS score at 24,48 and 72 hours after surgery,the patients in the Delta endoscopic surgery group had less pain than those in the traditional fenestration discectomy surgery group,and the difference was statistically significant(P<0.05).The ODI scores of postoperative patients in both surgery groups were significantly improved at 3 months after surgery and at the last investigation(P<0.05),but there was no statistical significance in postoperative ODI scores between the two surgery groups(P>0.05).Conclusion:It can be concluded from this study that there was no significant difference in operation curative effect,post-operative morbidity and recurrence rate between Delta endoscopic surgery group and fenestration discectomy surgery group,but Delta endoscopic technique has the following advantages compared with traditional fenestration discectomy:less invasive,less amount of blood lost during surgery,lower postoperative incision pain,faster post-operative rehabilitation,shorter hospital days,and improved turnover of hospitalized patients.Therefore,the Delta endoscopic surgery is more advantageous than fenestration discectomy in the selection of surgical methods for the treatment of lumbar disc herniation. |
PDF Full Text Request