经皮激光椎间盘汽化减压术治疗腰椎间盘突出症疗效与间盘退变程度的相关性分析  

Efficacy and Disc Degeneration Correlation with Percutaneous Laser Disc Decompression on Lumbar Disc Herniation

作　　者：朱换平[1] 赵继荣[1] 邓强[1] 

机构地区：[1]甘肃省中医院,兰州市730050

出　　处：《中国激光医学杂志》2015年第2期77-82,共6页Chinese Journal of Laser Medicine & Surgery

摘　　要：目的探讨经皮激光椎间盘汽化减压术(Percutaneous laser disc decompression,PLDD)治疗腰椎间盘突出症疗效与间盘退变程度的相关性。方法腰椎间盘突出症患者78例,术前采用Pfirrmann分级法对椎间盘退变程度进行评估后,进行PLDD治疗。于术前、术后7 d、3和12个月采用VAS疼痛评分法(Visual analogue scale,VAS)评价疼痛缓解情况,术后12个月采用改良Mcnab疗效标准评价临床疗效。结果组内比较,三组患者术后VAS评分均低于术前(P<0.05),其中PfirrmannⅡ组及PfirrmannⅢ组术后3和12个月VAS评分低于术后7 d,差异有显著意义(P<0.05)。组间比较,PfirrmannⅡ组VAS评分低于PfirrmannⅢ组,PfirrmannⅢ组VAS评分低于PfirrmannⅥ组;术后12个月PfirnnannⅡ级组、Ⅲ级组、Ⅳ级组优良率分别为100%,76.4%,29.4%;总有效率分别为100.0%,100.0%,82.4%。通过Spearman等级相关检验,三组患者术后12个月采用改良Macnab评价疗效,差异具有显著意义(P<0.001)。结论 PLDD治疗腰椎间盘突出症的临床疗效与椎间盘退化程度相关,Pfirrmann分级越低者疗效越好,而PfirrmannⅣ级和比其高一级的PfirrmannⅤ级患者不宜行PLDD治疗,在腰椎间盘突出症PLDD治疗中Pfirrmann分级系统有助于适宜患者的选择及疗效的预测。Objective To evaluate the efficacy and disc degeneration correlation with percutaneous laser disc decompression on lumbar disc herniation.Methods Altogether 78 patients with lumbar disc herniation were treated with PLDD.The degrees of disc degeneration were assessed before surgery and 7 days,3 months and 12 months after the surgery with Pfirrmann grading method respectively,the pain relief was evaluated with VAS pain scores,and the clinical efficacy was determined with modified Mcnab criteria.Results For all the three groups,the postoperative VAS scores were lower than the preoperative scores（P 0.05）.The VAS scores of Pfirrmann Ⅱ Group and Pfirrmann Ⅲ Group were lower 3 months and 12 months after the surgery than 7 days after the surgery,and the differences were statistically significant（P 0.05）.As to comparison between different groups,while Pfirrmann Ⅱ Group having a lower VAS score when compared with Pfirrmann Ⅲ Group,the VAS score of Pfirrmann Ⅲ Group was lower than that of Pfirrmann ⅥGroup.The excellence rates of Pfirrmann Ⅱ Group,Pfirrmann Ⅲ Group and Pfirrmann Ⅳ Group were 100.0%,76.4% and 29.4%respectively 12 months after the surgery,and the overall effective rates were 100.0%,100.0% and 82.4% respectively.The difference between these groups in curative efficacy obtained via spearman rank correlation test was statistically significant（P 0.001）.Conclusions For the treatment of lumbar disc herniation with PLDD,clinical efficacy is associated with disc degeneration.The efficacy improves with the dropping of the Pfirrmann grade.

关 键 词：腰椎间盘突出症 PLDD Pfirrmann分级 疗效 

分 类 号：R687.3[医药卫生—骨科学]