| background:With the progress of society and the rapid development of medical science,less trauma,to speed up postoperative rehabilitation,Short-term post-patient bed time and so on had attacted more and more people's attention.With the lumbar spine and The prevalence of cervical spondylosis of the spine surgery fieldincreased year by year,simplecon servative treatment has been difficult to achieve the purpose of treatment.Open surgeryhas been very mature after about half a century of continuous development Since the beginning,but thesurgery compications of traditional open surgery(Severe trauma,bleeding more,severe postoperative pain,intraoperative low back muscle muscle,soft tissue extensive stripping,etc.)also get wide range of attentionby the various aspects,these complications affects the therapeutic effect that Chronic low back pain caused by soft tissue injury.With the advent of other surgical minimally invasive surgery,the advantage of minimally invasive surgery(trauma small,Intraoperative blood loss less,the paraspinal soft tissue injury is small,postoperative pain is light,fast recovery and so on)have recieved people's favor,doctors of Spine surgery isalso want to use minimally invasive technique to solve the spine problem.Early,the medical doctors invent the small window was on the basis of open surgery,the advantages has been very obviousthan the open surgery,but with The rapid development of other surgical microscopy,the small windows gradually is not full enough to meet the requirements of people.With the endoscopic system in other surgical spreads,the spineendoscopic system also appears-lowly.the presence of MED(Microendoscopic Discectomy)made a great contribution,it can be said that epoch-making significance,its clinical efficacy to the people's approvain a period of timel.With the relevant micro-technology and microscopic devices high-speed development,more "micro"(The work of the casing directly into the spinal-canal,Percutaneous Endoscopic Lumbar Discectomy,PELD)gradually into our vision.We found that under the line to do the nucleus pulposus,Nerve root decompression through the intervertebral foramen(PELD),is more high degree of recognition with trauma is smaller,more secure,faster recoverymore than the MED.At present,with the rapid development of intervertebral fluoroscopy technology,a variety of manual surgery into the road in dicovered gradutly,which transtoraminal and interlaminar approach for perccutaneous endosopic is more common use.Those two kinds of hand surgery are popular in the small and small hospitals gradually,and more and more mature,compares-ions of these two is not lack,however,there is no systematic and complete comparisons,including the advantages and disadvantages of these two surgical procedures,and the best indications of the two kinds of manual surgery.Therefore,it aims to compare percutaneous andoscopic about the characteristics in transforaminal approach and interla-minar in tratement of L5/S1,to explore the best seletion by percutaneous endoscopy.Objective:To study the transforaminal(TF)and Interlaminar(IL)of percutaneous endoscopy,to get the best indications,compared the L5-S1 segmentThe patients who performed the two surgical procedures,showed the advantages and disadvantages of the two surgical procedures in the L5-S1 segment.Methodology:Collection of the patients with percutaneous andoscopic in transforaminal approach and interlaminar of DALIAN centre Hospital from April 2015 to 2016.Stati-stics the basic surgical data of the two approach include the number of puncture,the time of surgery,the number of fluoroscopy,the amount of blood flow,the patient Bed timeafter surgery,the time from surgery to discharge,complications,improvement of preoperative and postoperative(postoperative daytime,discharged VASScores and postoperative six months Oswestry dysfunction index),postoperative 6 months MacNab score,etc.,come to the best indication of these two approach.Comparedbasic technical information of all L5/S1 segment patients with PETD and PEID from the year 2015 to 2016 year in the DALIAN centre Hospital,obtained theGood and bad.Results:The sex composition,age composition of the patients who underwent the PETD surgery group and the patients who underwent PEID group surgery,There was no signif-icant difference in the type of nucleus pulposus(P>0.05).Patients underwent two type of surgery technologys in the L5-S1 segment.In PEID group,the operation time of 80 ±14.8min,the average number ofintraoperative C-arm perspective:5.0 ± 2 times,The average postoperative bedtime was 12 ± 2 h,the time from surgery to discharge was 3.0±1.8 d,and the amount of blood during surgery was about 16.8±7.1ml;PETD group were 131 ± 16.2min,15 ± 6 times,12.0 ± 1.1h,4.0 ± 1.2d,25.6 ± 2ml.In PEID,the operation time is shorter(P<0.01),the average number ofintraoperative C-arm perspective is litter(P<0.01),the amount of blood during surgery is lesser(P<0.01).There was no significant difference in bedtime and hospital stay(P>0.05).PEID group,3 cases of postoperative neuropathic pain,no complex.Hair,PETD group,postoperative complic taions of nerve root pain 4 cases,1 case of recurrence after three months,ease the symp toms after open surgery,no complex under 6-mouths,there was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The preoperative VAS and ODI of PEID grounps were 8 ± 1.6 points,(60.9 ± 15.3)%,and the VAS of postoperative day,discharge,the last time of Respectively were 5.3± 2.6,2.8±1.6,1.2 ± 0.9 points;the last follow-up ODI score(30.6 ± 16.3%);PETD group preoperative VAS,ODI were 7 ± 2.5 points,(60.8 ± 20.5)%,postoperative day,discharge,the last follow-up respectivelyVASscores were 5 ± 2,2 ± 1,1.3 ± 0.8 points,(32 ± 7.6)%.The VAS score and ODI at the last follow-up are improved apparently(P<0.01).There was no statistically significant difference between the VAS score and the ODI at the last follow-up Respectively(P>0.05).According to Macnab efficacy assessment criteria to assess the situation after 6 months,rate of greater than 90%of both patients under PETD and with PETD and PEIDin the L5S1 segment.Conclusion:Percutaneous andoscopic,whether PEID or PETD,the efficacy have no clearSignificant differenceof with open surgery,but the advantages of less blood and trauma small and quick recovery after surgery and he human body damage is small and so on are open surgery is not available.After a period of development,Percutaneous andoscopic will be the preferred Surgical program in spine surgury.When lumbar disc herniation on the L5/S1 segment,In order to achieve a good postoperative effect,we ne ed to select the appropriate treatment plan for the patients with the basic situation of the patients and the Imaging data. |
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