PELD术中选择单侧入路三根减压治疗腰椎间盘突出症疗效与安全性的前瞻性随机对照研究-中华老年骨科与康复电子杂志

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Title:: A prospective randomised controlled study of the efficacy and safety of triple root decompression for lumbar disc herniation by selecting a unilateral approach during PELD surgery

作者:: 李鹏1 赵成亮2 曾祥瑞3 王斐4 杨菲5; 154002 佳木斯市中医医院骨科1；266500 青岛大学附属医院脊柱外科2；154002 佳木斯市中医医院推拿科3，理疗科4，治未病科5

Author(s):: Li Peng1; Zhao Chengliang2; Zeng Xiangrui3; Wang Fei4; Yang Fei5.; 1Department of Orthopedics, Jiamusi Hospital of Traditional Chinese Medicine, Jiamusi 154002, 2Spine Surgery Department, Affiliated Hospital of Qingdao University, Qingdao 266000, China; 3Department of Massage, Jiamusi Hospital of Traditional Chinese Medicine, Jiamusi 154002, China; 4Department of Physical Therapy, Jiamusi Hospital of Traditional Chinese Medicine, Jiamusi 154002, 5Department of Preventive Medicine, Jiamusi Hospital of Traditional Chinese Medicine, Jiamusi 154002, China

关键词:: 单侧入路; 经皮椎间孔镜手术; 腰椎间盘突出症; 安全性

Keywords:: Unilateral approach; Percutaneous intervertebral laminectomy; Lumbar disc herniation; Safety

DOI:: 10.3877/cma.j.issn.2096-0263.2025.06.005

文献标志码:: A

摘要:: 目的研究旨在比较单侧与双侧入路经皮椎间孔镜（PELD）治疗L3～S1节段腰椎间盘突出症的效果，重点评估疼痛缓解、功能恢复、术后并发症和患者满意度，分析其疗效及安全性。方法研究纳入60例腰椎间盘突出症患者，男20例，女40例，年龄18～70岁，平均（48.8±6.1）岁，按手术入路分为单侧入路组和双侧入路组，每组30例。所有患者均接受PELD手术治疗，术后随访6个月，主要评估指标包括视觉模拟评分（VAS）、日本骨科协会评分（JOA）、Oswestry功能障碍指数（ODI）和术后并发症。结果单侧入路组术前、术后1周、术后1个月、术后3个月、术后6个月VAS评分分别为（7.1±1.2）、（4.3±0.8）、（2.2±0.6）、（1.6±0.5）、（1.3±0.4），双侧入路组分别为（7.3±1.2）、（4.7±0.9）、（2.5±0.7）、（2.0±0.6）、（1.7±0.5），不同组别间、时间点间差异有统计学意义（F=4.251，P=0.04；F=325.604，P=0.000），组别与时间点间存在交互作用（F=3.201，P=0.015）；单侧入路组术前、术后1周、术后1个月、术后3个月、术后6个月JOA评分分别为（12.4±2.1）、（16.1±1.6）、（18.4±1.4）、（20.1±1.3）、（20.8±1.2），双侧入路组分别为（12.5±2.2）、（15.7±1.5）、（17.9±1.3）、（17.9±1.3）、（20.0±1.1），不同组别间、时间点间差异有统计学意义（F=5.128，P=0.128；F=598.354，P=0.000），组别与时间点间存在交互作用（F=15.246，P=0.015）；单侧入路组术前、术后1周、术后1个月、术后3个月、术后6个月Oswestry功能障碍指数分别为（51.8±7.0）、（37.5±6.3）、（30.2±5.5）、（24.5±4.7）、（20.8±4.1）、双侧入路组分别为（52.1±7.3）、（39.0±6.5）、（31.0±5.8）、（26.0±4.9）、（22.1±4.4），不同组别间、时间点间差异有统计学意义（F=4.317，P=0.043；F=485.726，P=0.000），组别与时间点间存在交互作用（F=4.128，P=0.003）；双侧入路组感染发生率为13.3%，明显高于单侧入路组的0%（P＜0.05）。两组在术后患者满意度方面无显著差异。结论单侧入路PELD手术在减轻疼痛、提高功能恢复和减少术后并发症方面优于双侧入路，且两组患者的术后满意度均较高。单侧入路作为治疗L3～S1节段腰椎间盘突出症的有效选择，具有较好的临床效果。

Abstract:: Objective The aim of the study was to compare the effects of unilateral and bilateral approach percutaneous interlaminar laminectomy (PELD) for the treatment of lumbar disc herniation at L3-S1 segment, focusing on the assessment of pain relief, functional recovery, postoperative complications, and patient satisfaction, and to analyse its efficacy and safety. Methods Sixty patients with lumbar disc herniation were included in the study, there were 20 male cases and 40 female cases, aged from 18 to 70 years, with an average age of (48.8±6.1) years, and were divided into unilateral approach group and bilateral approach group according to the surgical approach, with 30 cases in each group. All patients were treated with PELD surgery and followed up for 6 months after surgery. The main assessment indexes included visual analogue score (VAS), Japanese Orthopaedic Association score (JOA), Oswestry dysfunction index (ODI) and postoperative complications. Results The VAS scores of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (7.1±1.2), (4.3±0.8), (2.2±0.6), (1.6±0.5), and (1.3±0.4), respectively. Those of the bilateral approach group were (7.3±1.2), (4.7±0.9), (2.5±0.7), (2.0±0.6), and (1.7±0.5), respectively. There were statistically significant differences between different groups and time points (F=4.251, P=0.04; F=325.604, P=0.000), and there was an interaction between groups and time points (F=3.201, P=0.015). The JOA scores of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (12.4±2.1), (16.1±1.6), (18.4±1.4), (20.1±1.3), and (20.8±1.2), respectively. Those of the bilateral approach group were (12.5±2.2), (15.7±1.5), (17.9±1.3), (17.9±1.3), and (20.0±1.1), respectively. There were statistically significant differences between different groups and time points (F=5.128, P=0.128; F=598.354, P=0.000), and there was an interaction between groups and time points (F=15.246, P=0.015). The Oswestry Disability Index of the unilateral approach group at preoperative, 1 week postoperative, 1 month postoperative, 3 months postoperative and 6 months postoperative were (51.8±7.0), (37.5±6.3), (30.2±5.5), (24.5±4.7), and (20.8±4.1), respectively. Those of the bilateral approach group were (52.1±7.3), (39.0±6.5), (31.0±5.8), (26.0±4.9), and (22.1±4.4), respectively. There were statistically significant differences between different groups and time points (F=4.317, P=0.043; F=485.726, P=0.000), and there was an interaction between groups and time points (F=4.128, P=0.003). The infection rate of the bilateral approach group was 13.3%, significantly higher than that of the unilateral approach group (0%) (P<0.05). There was no significant difference between the two groups in terms of postoperative patient satisfaction (P>0.05). Conclusion The unilateral approach to PELD surgery was superior to the bilateral approach in reducing pain, improving functional recovery, and reducing postoperative complications, and both groups had higher postoperative patient satisfaction. Unilateral approach as an effective choice for the treatment of lumbar disc herniation at L3-S1 segment has better clinical results.

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

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