| Objectives:To compare the clinical results of percutaneous endoscopic and micr-oendoscopic via interlaminar approach for L5/S1 disc herniation also to compare the clinical results of percutaneous endoscopic interlaminar discectomy vs micro-endoscopic discectomy for L5/S1 disc herniation,in order to provide some refere-nces for clinical treatment of L5/S1 disc herniation.Methods:l.Part one:Using retrospective analysis,from December 2010 to Octob-er 2014,a total of 164 patients were divided to percutaneous endoscopic interlam-inar discectomy(PEID)group and microendoscopic discectomy(MED)group accor-ding to different surgical methods,there were 84 patients in PEID group,there were 80 patients in MED group.The age,sex,duration,length of skin incision,op-eration time,intraoperative fluoroscopy times,postoperative bed rest time,hospital days postoperatively,complications and surgical results between 2 groups were co-mpared.In preoperative,1 day postoperative,lmonth postoperative,3 months posto-perative and 12 months postoperative,both groups were followed up by using the following measurements:Oswestry disability index(ODI),visual analogue scale(V AS).Both groups were followed up by using modified Macnab classification.2.Part two:From October 2013 to October 2014,there were 46 patients in PEID group,there were 20 patients in MED group.The operation time,intraopera-tive fluoroscopy times between 2 groups were compared.Results:1.Part one:There was no significant difference in age,sex,duration,pre-operative VAS or preoperative ODI between two groups(P>0.05).In PEID group,the length of skin incision was 6.9±0.8mm,the operation time was 69.7±22.9 mi-ns,the intraoperative fluoroscopy times were 5.6±1.0,the postoperative bed rest t-ime was 6.4±3.9 hours,hospital days postoperatively were 3.0±1.3 days;while in MED group,the length of skin incision was 17.9±2.2mm,the operation time was 52.9±8.5 mins,the intraoperative fluoroscopy times were 2.8±0.7,the postoperative bed rest time was 39.5±15.8 hours,the hospital days postoperatively were 6.1±1.8 days.There was significant difference in length of skin incision,operation tim-e,intraoperative fluoroscopy times,postoperative bed rest time and hospital days postoperatively between two groups(P<0.05).The follow-up time of two groups was 12?26 months and the average was 19.4 months.In PEID group,preopera-tive VAS was 8.4±1.2,preoperative ODI was(55.2±11.5)%;1 day postoperati-ve VAS was 3.2±1.0,1 day postoperative ODI was(22.6±14.0)%;1 month po-stoperative VAS was 2.3±0.6,1 month postoperative ODI was(24.7±14.3)%;3 months postoperative VAS was 1.5±1.0,3 months postoperative ODI was(22.8±11.2)%;12 months postoperative VAS was 1.2±0.7,12 months postoperative O DI was(10.7±5.1)%.Similarly,in MED group,were 8.1±1.4?(52.4 ±4.4)%,4.0±1.2?(26.2±12.2)%,2.2±0.9?(25.6±11.1)%,1.7±0.8?(23.4±11.3)%,1.3±0.5?(10.9?4.0)%.There was no significant difference in 1 day postoperative VAS?ODI,1 month postoperative VAS?ODI,3 months postoperative VAS?ODI and 12 m-onths postoperative VAS?ODI vs preoperative VAS?ODI in each group(P>0.05).There was significant difference in 1 day postoperative VAS between two gr-oups(P<0.05).There was no significant difference in preoperative VAS?ODI,1 month postoperative VAS?ODI,3 months postoperative VAS?ODI and 12 mont-hs postoperative VAS?ODI between two groups(P>0.05).In PEID group,1 pati-ent was complicated with postoperative S1 dysesthesia,1 patient experienced a dural tear and 0 patient had recurrent disc herniation.while in MED group 1 patient experienced a dural tear and 0 patient had recurrent disc herniation.Ther-e was no difference in complication rates or recurrent rates between 2 groups(P>0.05).The satisfaction rate of modified Macnab classification in PEID group was 91.7%:there were 65 excellent,12 good,7 fair;and the satisfaction rate in MED group was 95.0%:there were 60 excellent,16 good,4 fair.There was no difference between two groups(P>0.05).Part two:From October 2013 to October 2014.There were 46 patients in P EID group,operation time was 52.7±10.1mins,intraoperative fluoroscopy times were 3.1±1.2.There were 20 patients in MED group,operation time was 53.1±8.4mins,intraoperative fluoroscopy times were 2.8±0.5.between 2 groups were com-pared.There was no significant difference in operation time and intraoperative fl-uoroscopy times between two groups(P>0.05).Conclusions:1.The short-term clinical results of the PEID are equal to the ME D for the L5/S1 disc herniation.Although the early of PEID has longer operation time and more intraoperative fluoroscopy times,PEID is equal to the MED inop-eration time and intraoperative fluoroscopy times with the deepened understandin-g of PEID and skilled operation.PEID has smaller incision,less postoperative pain,shorter postoperative bed rest time and shorter hospital days postoperatively.PEID fits in with minimally invasive concept,and it is worth surgeons in-depth study.2.PEID is a good method in the treatment of L5/S1 disc herniation,espe-cially with high iliac crest and(or)hypertrophy of transverse process of the fifth lumbar vertebra. |
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