| [Purpose]Lumbar disc herniation(LDH)is one of the most common diseases in orthopedics,and it is also the main cause of low back pain.The current incidence is increasing,which seriously affects the quality of life of the majority of patients.Its treatment is also receiving much attention.To compare the recent treatment of lumbar disc herniation(LDH)with percutaneous endoscopic lumbar discectomy(PELD)and open fenestration discectomy(OD)Clinical efficacy in order to find more optimal surgical treatment.[Method]Part ?:To collect and administer percutaneous endoscopic lumbar discectomy(PELD)and open fenestration discectomy(OD)from October 2014 to October 2017 in our department.detailed case data for the treatment of lumbar disc herniation(LDH)and perform the following analysis:1.Comparison of the efficacy of the two surgical methods:1.1 Analysis and comparison of the differences in basic data such as age,gender,and diseased segments between the PELD group and the OD group;1.2 analysis of the difference between the surgery time,intraoperative blood loss and other intraoperative indicators of the PELD group and OD group;1.3 analysis of the comparison of PELD group and OD group postoperative bed time,efficacy score(VAS score,JOA score),postoperative complications and other clinical efficacy of the difference.2.Percutaneous endoscopic lumbar discectomy(PELD)learning curve analysis:2.1 Based on the length of hospital stay,the PELD components were studied and proficient,and the differences between the two groups on gender,age,and diseased segments were analyzed.2.2 Analyze the difference between intraoperative parameters such as operation time and intraoperative blood loss between the study group and the proficiency group,and perform the continuous change chart analysis;2.3 Analysis of the comparison of the efficacy of the study group and the skilled group(VAS score,JOA score)and postoperative complications such as clinical efficacy of the differences.Part ?:Computer searches of PubMed,Medline,Embase,Cochrane Library,OVID,Web of Science,and other databases were completed by December 2017.The search terms were lumbar disc herniation(LDH),Percutaneous endoscopic lumbar discectomy(PELD),and percutaneous transforaminal endoscopic discectomy.(PTED),YES,TESSYS,Microendoscopic Discectomy(MED),etc.,according to inclusion criteria(single-segment disc herniation,normalized conservative treatment for more than 3 months,no prior history of related spinal surgery)and exclusion criteria(lumbar instability,Tumors,degenerative spinal stenosis,infection,multi-segmental protrusion,previous history of lumbar spine surgery,and recurrence of herniated discs.Screening of literature,selection of target literature,and quality assessment(Cochrane Risk Bias Assessment Tool and NOS Scale),Extraction of observational indicators(mean age,surgical incision length,operative time,intraoperative blood loss,average length of hospital stay,VAS score,SF-36 score,postoperative excellent rate,postoperative complication rate,imaging changes)And data,using Revman 5.3.5 Meta-analysis of the indicators,the results,[Results]Part I:Collecting and arranging our department from October 2014 to October 2017 using percutaneous endoscopic lumbar discectomy(PELD)and open fenestration discectomy(open fenestration discectomy,OD)Part 1 of the detailed treatment of lumbar disc herniation(LDH):1.Comparison of the efficacy of the two surgical methods:1.1 A total of 150 cases were collected,aged 15-80 years,including 115 cases of percutaneous transforaminal endoscopic surgery(PELD group)and 35 cases of open laminectomy(OD group).The average age of PELD group was 46.0±15.8,mean age of OD group was 41.9 ± 11.0;sex was PELD group of 64 males and 51 females;OD group was 20 males and 15 females;lesion segment was PELD group L4/5 was 57 cases,L5/S1 was 58 For example,there were 17 cases of L4/5 in OD group and 18 cases of L5/S1.Statistical analysis showed that there was no significant difference in age,gender,and diseased segments between the PELD group and the OD group(P>0.05).1.2 The average operation time of PELD group was 128.4 ± 11.8 min.The average intraoperative blood loss was 10.0(10.0,15.0)ml.The average operation time in OD group was 117.7 ± 14.4 minutes.The average intraoperative blood loss was 60.0(50.0,100.0)ml.Compared with the OD group,the PELD group had a longer operation time.However,the amount of intraoperative blood loss was lower in the PELD group(P<0.05).1.3 Postoperative effect:VAS score:There was no significant difference between the two groups(P>0.05).Analysis at different time points in the same group showed that VAS scores gradually decreased compared with before(P<0.05);JOA score:two groups There was no significant difference between the two groups(P>0.05).Analysisat different time points in the same group showed that JOA scores were higher than before(P<0.05).There was no significant difference in postoperative recurrence between the PELD group and the OD group(P>0.05).2.Percutaneous transforaminal discectomy(PELD)learning curve analysis:2.1 According to length of stay,115 patients in the PELD group were divided into a study group and a proficiency group.The study group consisted of 57 patients.The average age was 46.3 ± 14.2.There were 30 males and 27 females.The L4/5 prominence was 26 and the L5/S1 prominence 31.Example:The average age of the skilled group was 45.8 ± 17.3.There were 34 males and 24 females.The L4/5 highlighted 31 patients,and the L5/S1 prominent 27 patients.Statistical analysis showed that there was no significant difference in the basic data(age,sex,and diseased segments)between the PELD group and the OD group(P>0.05).2.2 The average operative time of the study group was 138.2 ± 7.9 min.The average intraoperative blood loss was 13.0±3.5 ml.The average operation time of the skilled group was 118.7 ±5.3 minutes.The average intraoperative blood loss was 9.6±2.7 ml.The operation time and intraoperatively The amount of bleeding in the proficient group was lower than that in the study group,and the difference was statistically significant(P<0.05).Analysis of the continuous changes in the operative time and intraoperative blood loss showed that the plateau period was 65-75 cases.2.3 Postoperative efficacy:VAS score:There was no significant difference between the two groups(P>0.05).Analysis at different time points in the same group showed that VAS scores gradually decreased compared with before(P<0.05);JOA score:between the two groups The difference was not statistically significant(P>0.05).Analysis at different time points in the same group showed that the JOA score was higher than before(P<0.05);the postoperative recurrence rate of the skilled group was higher than that of the study group(P<0.05).Part ?:After the search,16 target articles were obtained(1333 cases,668 in the PELD group,665 in the OD group),14 were randomized controlled trials(RCTs),2 were case control trials,and the Cochrane risk bias evaluation values were both More than 60%,NOS scale scores are more than 8 points.Extraction of observational indicators and data showed that the average age(9 articles),incision length(6 articles),operation time(11 articles),intraoperative blood loss(10 articles),average length of stay(11 articles),VAS scores(10 articles),SF-36 scores(3 articles),postoperative excellent rate(11 articles),incidence of postoperative complications(13 articles),imaging changes(3 articles)Meta analysis results(RCT and case-control trials in subgroup analysis):PELD and OD groups had no statistically significant differences in patient age,operative time,postoperative response score,good rate,and complications.(P>0.05),PELD group had better results in terms of surgical incision size,intraoperative blood loss,average length of hospital stay,and postoperative imaging changes.The differences were statistically significant(P<0.05).Proximal postoperative recurrence rate is higher than that of study group(P<0.05).[Conclusion]1.The clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)and conventional open fenestration discectomy(OD)in the treatment of lumbar disc herniation(LDH)is similar.2.The learning curve of percutaneous transforaminal lumbar discectomy(PELD)reached a stable plateau after 65 cases.3.Percutaneous endoscopic lumbar discectomy(PELD)has the advantages of less trauma,fewer complications,short hospital stay,and rapid recovery. |
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