西南医科大学学报2025，Vol.48Issue(3)：281-286,6.DOI:10.3969/j.issn.2096-3351.2025.03.009
基于倾向性匹配法分析侧后路PELD术治疗腰椎间盘突出症患者的疗效及并发症
Efficacy and Complications of PELD Through Lateral-Posterior Approach for Lumbar Disc Herniation Patients Based on Propensity Score Matching
摘要
Abstract
Objective The purpose of this study is to explore the effects of percutaneous endoscopic lumbar discectomy(PELD)via the lateral-posterior approaches on postoperative lumbar mobility,lumbar function,quality of life,and the incidence of complications in patients with lumbar disc herniation,based on propensity score matching.Methods A total of 180 patients with lumbar disc herniation treated at Kaifeng People's Hospital from August 2021 to January 2024 were enrolled in this study.Among them,93 patients underwent posterolateral percutaneous endoscopic lumbar discectomy(PELD group),while 87 patients underwent posterior midline approach interlaminar fenestration discectomy(fenestration group).Propensity score matching based on baseline char-acteristics was performed between the two groups,resulting in 75 successfully matched pairs.Comparisons were made between the two groups regarding surgical parameters,postoperative pain severity,changes in stress markers,lumbar mobility,functional outcomes,quality of life at preoperative and 6-month postoperative stages,as well as complication rates.Results After propensity score match-ing,compared with the fenestration group,incision length was shorter,intraoperative blood loss was less,and bed rest time was shorter in PELD group(P<0.05).Within 1 to 7 days after surgery,pain relief was observed in both groups,with the PELD group experiencing significantly milder pain than the fenestration group(P<0.05).At 1h after surgery,there was no significant difference in stress indexes between the two groups(P>0.05).At 12 hours after surgery,the levels of norepinephrine(NE),prostaglandin E2(PGE2),and cortisol(Cor)were lower than those at 1 hour after surgery in both groups.These levels were also significantly lower in the PELD group compared to the fenestration group(P<0.05).Before surgery,there was no significant difference in lumbar range of motion or lumbar function between the two groups(P>0.05).At 6 months after surgery,lumbar range of motion and lumbar function were improved in both groups,and the improvement was better in the PELD group than in the fenestration group(P<0.05).Before sur-gery,there was no significant difference in quality of life between the two groups(P>0.05).At 6 months after surgery,quality of life scores were increased in both groups,which were higher in the PELD group than in the fenestration group(P<0.05).There was no sig-nificant difference in incidence of complications(postoperative infection,leakage of cerebrospinal fluid,re-protrusion of intervertebral disc)between the PELD group and the fenestration group(P>0.05).Conclusion Compared with intervertebral fenestration and dis-cectomy through posterior-median approach,PELD through lateral-posterior approach offered greater advantages in improving lumbar range of motion,functional recovery,and quality of life.关键词
腰椎间盘突出症/髓核摘除术/侧后路经皮内窥镜/后正中入路椎板间开窗髓核摘除术/腰椎活动度Key words
Lumbar disc herniation/Discectomy/Percutaneous endoscopic lumbar discectomy/Posterior-median approach/Lumbar range of motion分类
临床医学引用本文复制引用
冯其斌,董小华,潘国强,何浩..基于倾向性匹配法分析侧后路PELD术治疗腰椎间盘突出症患者的疗效及并发症[J].西南医科大学学报,2025,48(3):281-286,6.基金项目
河南省医学科技攻关计划联合共建项目(LHGJ20220925) （LHGJ20220925）
