Objective: To evaluate the incidence, causes and prognosis of the low back pain and posterior thigh pain in the early stage after percutaneous endoscopic lumbar discectomy (PELD). Methods: A total of 88 patients who underwent PELD from December 2017 to June 2018 in the First Affiliated Hospital of Anhui Medical University were enrolled in this study. PELD was performed by posterior-lateral approach and the interlaminar approach in 44 cases, respectively. During the 3-month of follow-up post PELD, the number of cases who suffered low back pain and posterior thigh pain, complications and postoperative treatments were all followed and evaluated. Results: All the 88 cases underwent PELD successfully. Twelve cases (27.3%) suffered low back pain after PELD by posterior-lateral approach totally, 4 patients (9.1%) were new cases and the low back pain aggravated after PELD in the other 8 cases (18.2%). The posterior thigh pain occurred in 9 cases (20.4%) after PELD in posterior-lateral approach group, of them, 5 patients (11.4%) were new cases and it was aggravated in 4(9.1%) cases after the surgery. As for the low back pain after PELD performed by the interlaminar approach, 7(15.9%) cases suffered low back pain and 1 case (2.3%) occurred after surgery. The posterior thigh pain happened in 5 cases (11.4%) after PELD in the interlaminar approach group, 2 cases (4.6%) were new cases and the pain was aggravated in 3 cases (6.8%) after surgery. According the classification of MacNab, 42 of 88 cases were classified excellent, 25 cases good, 17 cases fair and 4 cases poor after PELD. Totally 18 cases were classified into fair and poor because of the low back pain or the posterior thigh pain during the follow-up. Furthermore, none of 88 cases had infection or nerve root injury after surgery. All cases suffering the low back pain or the posterior thigh pain treated conservatively and no one needed surgery again. Conclusions: The pain in low back or posterior thigh may be one of the complications after PELD, and it can be treated conservatively. Incidence of the low back pain or the posterior thigh pain after PELD with posterior-lateral approach is higher than that in patients with interlaminar approach, and it may affect the efficacy of PELD.
目的： 评估经皮内镜下腰椎间盘摘除（PELD）术后3个月内新发患侧腰痛、大腿后方痛或较术前加重的发生率，并探讨其可能原因及预后。 方法： 回顾性分析2017年12月至2018年6月安徽医科大学第一附属医院骨科诊断为腰椎间盘突出症行PELD手术并随访成功的88例患者的临床资料。经椎间孔侧入路行PELD和经后方椎板间入路行PELD各44例。所有患者随访时间为术后3个月，评估指标包括术后新发腰痛及大腿后方痛或较术前加重的例数、手术并发症、术后处理及疗效。组间术后疼痛发生率比较采用χ(2)检验。 结果： 经椎间孔侧入路行PELD者44例，随访期存在腰痛12例（27.3%），术后新发4例（9.1%），较术前加重8例（18.2%）；大腿后方痛9例（20.4%），术后新发5例（11.4%），加重4例（9.1%）。经椎板间后入路行PELD者44例，术后存在腰痛7例（15.9%），新发1例（2.3%），加重6例（13.6%）；大腿后方痛5例（11.4%），新发2例（4.6%），加重3例（6.8%）。经侧入路PELD的腰痛和大腿后方痛发生率均高于后入路。依据MacNab标准，88例PELD疗效为优42例（47.7%），良25例（28.4%），中17例（19.3%），差4例（4.6%）。两种入路共18例患者因随访期腰痛和（或）大腿后方痛疗效评级为中和差。所有患者均未发生神经损伤、血肿及感染。所有术后腰腿痛患者给予口服药物和康复治疗后均缓解，无一例需再次手术治疗。 结论： PELD术后早期易新发腰痛或大腿后方痛，甚至较术前加重，并且经椎间孔侧入路的发生率高于经后方椎板间入路。疼痛经保守治疗均可以得到缓解，但仍是影响手术疗效的因素之一。.
Keywords: Complications; Percutaneous endoscopic lumbar discectomy; Surgery.