| Objective:Both percutaneous endoscopic transforaminal discectomy(PETD)and percutaneous endoscopic interlaminal discectomy(PEID)can achieve good clinical results for massive lumbar disc herniation,while there are differences in some aspects between the two approaches,such as the difficult degree of punctuation and nerve root decompression,incidence of complication,etc.This dissertation makes a comparison between the two approaches in the above aspects according to a cohort study.Materials and methods:In this historical cohort study,a total of 75 consecutive patients with massive lumbar disc herniation who underwent either percutaneous endoscopic transforaminal discectomy(PETD)(Group A)or percutaneous endoscopic interlaminal discectomy(PEID)(Group B)were recruited from the department of orthopedics of China-Japna union hospital between September 2015 and September 2017.In group A,there are 28 males,10 females;mean±SD :age 34.39±9.36 years;mean±SD :course of disease 3.51±2.38 months;and preoprative visual analogue scale(VAS)of back/leg and Oswestry disability index(ODI)are 4.14±1.08/8.25±0.96,79.62±8.17.In group B,there are 22 males,15 females;mean±SD : age 35.92±9.16 years;mean±SD:course of disease3.26±2.14months;and preoprative VAS of back/leg and ODI are 4.4±1.22/7.92±0.98,80.21±7.76.There is no significant difference between the two groups in these aspects mentioned(P>0.05).The total operative time,the time of disc resection and nerve root decompression,VAS scores of the next day after operation and the time of postoperative hospitalization are recorded from the medical records.The total operative time begins immediately after starting puncture and is ended when completing suture of incision.The time of disc resection and nerve root decompression is recorded by the video system.The severer side leg of patients with bilateral symptoms is selected as VAS of leg.VAS scores of 1 month after operation and the last follow-up,ODI of 1,3 month(s)after operation and the last follow-up are attained from return visit records or by Wechat and telephones,and the modified MacNab is recorded at the last follow-up.The date is analyzed by SPSS.22.0.Inter-group comparison: the count data is checked by t-test and the measurement data is checked by Chi-square test or Fisher test,intra-group comparison:the date is checked by variance analysis of single repeated measurement data.The test level is bilateral ?=0.05 and P<0.05 meant statistically significant difference.Results:All patients underwent procedures and got fellow-up successfully.The total operative time: Group A 134.95±40.78 min,Group B 117.24±34.94min;time of disc resection and nerve root decompression: Group A 56.76±25.81 min,Group B 79.56±26.57min;time of postoperative hospitalization: Group A 3.42±1.20 d,Group B 4.00±1.25d;time of final fellow-up;Group A 12.6±4.3m,Group B 12.2±4.1m.VAS of back/leg of 1 day,1 month after operation and the last follow-up of Group A are 2.75±0.81/4.15±1.21,0.75±0.61/0.85±0.31,0.69±0.51/0.65±0.71.ODI of 1,3 month(s)after operation and the last follow-up of Group A are 24±4.3,8.2±3.0,7.6±2.1.VAS of back/leg of 1 day,1 month after operation and the last follow-up of Group B are 2.71±0.78/4.20±1.19,0.68±0.59/0.81±0.73,0.62±0.53/0.61±0.73;ODI of 1,3 month(s)after operation and the last follow-up of Group B were 23±4.1,8.3±2.9,7.7±1.9.In Group A,30 cases are excellent 3 are good,3 are moderate and 3 are bad according to modified Macnab.In group B,29 cases are excellent,2 are good,5 are moderate and 1 is bad according to modified Macnab.There are1 complications and 3 recurrences in group A and 7 complications and 1 recurrence in group B.Inter-group comparison:the total operative time of Group A is significantly longer than that of Group B while the time of nerve root decompression and postoperative hospitalization of Group A is shorter and the incidence of postoperative complications of group A is lower.There is no significant difference in VAS of back/leg,ODI,the modified MacNab,and the incidence of recurrence between the two groups.Intra-group comparison:both groups exhibit significant improvements in VAS of back/leg,and ODI(P < 0.05)after operation,and the scores gradually decrease with time.Conclusion:1.Compared to PEID,PETD is more difficult in puncturation,while is easier to resect disc and decompress the nerve root.2.The incidence of postoperative complications of PEID is higher than that of PETD,and the postoperative hospitalization time of PEID is longer.3.Patients with massive lumbar disc herniation treated with PEID are more tolerant during operation than PETD.4.Both PETD and PEID can achieve good clinical results with no significant diffirence by strict indication. |
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