経皮的内視鏡下腰椎椎間板ヘルニア摘出術―後方手術（Love変法）と比較した手術成績と問題点

Initial Outcomes and Problems with Percutaneous Endoscopic Lumbar Discectomy (PELD) in Comparison with Conventional Open Discectomy

　腰椎椎間板ヘルニアに対する経椎間孔アプローチの経皮的内視鏡下ヘルニア摘出術(以下PELD)とLove変法の手術成績を後ろ向き調査し，その侵襲性と問題点を検討した．対象は2007年5月から2008年5月までに施行したPELD12例とLove変法14例で，術前後のJOAスコアと改善率，手術時間，術中出血量，術当日・翌日の鎮痛薬使用量，術後入院期間を調査した．最終評価時の臨床成績に統計学的有意差はなかったが，PELD群は鎮痛薬の使用量が少なく，術後入院期間が有意に短かった．しかしexiting nerve root損傷を3例に認め，その適応と導入は慎重でなければならないと考えた．

　The purpose of this study was to compare the clinical results of percutaneous endoscopic lumbar discectomy (PELD) with those of open discectomy.　The records of 12 consecutive patients treated by transforaminal PELD at one institution and 14 consecutive patients treated by partial hemilaminectomy and posterior lumbar discectomy at another institutions between May 2007 and May 2008 were reviewed.　The follow-up period in this study was at least 6 months.　The two groups of patients compared in relation to: age, sex, body height, body weight, body mass index (BMI), level of morbidity, laterality of radiculopathy, preoperative Japanese Orthopedic Association (JOA) score, operation time, intraoperative blood loss, complications, postoperative analgesic drug dosages of on postoperative day (POD) 0 and POD 1, length of postoperative hospital stay, postoperative JOA score, and recovery rate.　Intraoperative blood loss was minimal in both groups, and the length of postoperative hospital stay was shorter in the PELD group compared with open discectomy group.　The analgesic drug doses tended to be lower in PELD group.　However, 3 neurological deficits were observed in the PELD group.　The possibility of nerve injury, including injury of the exiting nerve root, should be kept in mind when performing PELD.