目的 探究两种不同手术方式治疗L5～S1腰椎间盘突出症(Lumbar disc herniation,LDH)患者的效果。方法 选取我院90例L5～S1 LDH患者(2017年6月～2020年9月),按随机数字表法分成PTED组(n=45)、FD组(n=45)。FD组接受开窗髓核摘除术(Fenestration discectomy,FD)治疗,PTED组接受经皮椎间孔镜下髓核摘除术(Percutaneous transforaminal endoscopic discectomy,PTED)治疗。对比2组围术期指标、术前、术后1个月、3个月Oswestry功能障碍指数问卷表(Oswestry disability index,ODI)评分、术前、术后3d、7d视觉模拟评分法(Visual analogue scale,VAS)评分、创伤应激因子[促肾上腺皮质激素(Adrenocorticotropic Hormone,ACTH)、皮质醇(Cortisol,Cor)]水平。结果 PTED组切口长度及住院时长较FD组短,术中失血量较FD组少(P＜0.05)；PTED组术后1个月、3个月ODI评分较FD组低(P＜0.05)；PTED组术后3d、7d VAS评分较FD组低(P＜0.05)；PTED组术后12h血清ACTH、Cor水平较FD组低(P＜0.05)。结论 与FD治疗L5～S1 LDH患者相比,应用PTED治疗于优化围术期指标、减轻术后疼痛感及创伤应激、改善腰椎功能方面更具优势,值得临床推广。

Objective To explore the effects of two different surgical methods in the treatment of patients with L5～S1 lumbar disc herniation (LDH). Methods 90 patients with L5～S1 LDH in our hospital (from June 2017 to September 2020) were selected and divided into PTED group (n=45) and FD group (n=45) according to the random number table method. The FD group received Fenestration discectomy (FD) treatment, and the PTED group received Percutaneous transforaminal endoscopic discectomy (PTED) treatment. Compare the two groups of perioperative indicators, preoperative, 1 month, 3 months postoperative Oswestry disability index questionnaire (Oswestry disability index, ODI) scores, preoperative, postoperative 3d, 7d visual analogue scale (Visual analogue scale, VAS) score, traumatic stress factor [Adrenocorticotropic Hormone (ACTH), Cortisol (Cortisol, Cor)] levels. Results The incision length and length of hospital stay in the PTED group were shorter than those in the FD group, and the intraoperative blood loss was less than that in the FD group (P＜0.05); the PTED group had lower ODI scores at 1 and 3 months after surgery than the FD group (P＜0.05); The VAS scores of the PTED group were lower than those of the FD group at 3 and 7 days after the operation (P<0.05); the serum ACTH and Cor levels in the PTED group were lower than those in the FD group at 12 hours after the operation (P<0.05). Conclusion Compared with FD treatment of L5～S1 LDH patients, the application of PTED therapy has more advantages in optimizing perioperative indicators, reducing postoperative pain and traumatic stress, and improving lumbar spine function. It is worthy of clinical promotion.