胶原酶髓核溶解术和椎间孔镜术治疗腰椎间盘突出症疗效对比  

A Comparison of the Effect between Collagenase Chemonucleolysis and Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation

作　　者：巨辉[1] 白国强[1] 杨磊[1] 刘丽[1] 

机构地区：[1]四川省科学城医院疼痛科,四川绵阳621900

出　　处：《医学综述》2015年第19期3640-3642,共3页Medical Recapitulate

摘　　要：目的比较胶原酶髓核溶解术和椎间孔镜腰椎间盘切除术(PTED)治疗单节腰椎间盘突出症的临床疗效。方法选择2013年3月至2014年1月在四川省科学城医院疼痛科住院的68例单节腰椎间盘突出症患者,按照随机数字表法分为髓核溶解术组和PTED组,各34例。髓核溶解术组采用胶原酶髓核溶解术,PTED组采用椎间孔镜进行腰椎间盘切除,术前、术后3 d、1个月、3个月及6个月分别采用视觉模拟评分(VAS)法进行疗效评价;术后3 d、术后1个月、术后3个月、术后6个月采用改良的Macnab标准进行疗效评价。结果与术前比较,两组术后各时间点VAS评分均较术前明显下降,差异有统计学意义(P<0.05)。术后3 d及1个月PTED组优良率显著高于髓核溶解组,差异有统计学意义(P<0.05),而术后3个月及6个月两组的优良率比较差异无统计学意义(P>0.05)。结论 PTED与胶原酶髓核溶解术治疗单节段腰椎间盘突出症均可取得良好的临床效果,但PTED在短期内快速缓解腰腿痛方面明显优于胶原酶髓核溶解术。Objective To compare the clinical effect of collagenase chemonucleolysis and percutaneous transforaminal endoscopic diseectomy（PTED） in the treatment of single segment of lumbar disc herniation. Methods A total of 68 patients with single segment lumbar disc herniation in Science City Hospital of Sichuan Province from Mar. 2013 to Jan. 2014 were included in the study, and were randomly divided into chemoonucleolysis group and PTED group with 34 cases in each group according to random number table method. The chemonucleolysis group was treated with collagenase chemonucleolysis, and the FFED group was treated with PTED. visual analog scale（VAS） at the time points of preoperative and postoperative 3rd day,1 month ,3 months and 6 months were collected to evaluate the curative effect;after 6 months, modified Macnab criteria was adopted for efficacy evaluation. Results Compared with the preoperative, VAS score in two sets of various postoperative time points were significantly decreased, the diffeences were statistically significant （ P 〈 0.05 ） ; The excellent efficacy rate of PTED group after 3 days and 1 month of PTED group was better than the ehemonucleolysis group（ P 〈0.05 ） ,but the excellent rate of the two groups had no statistiealy sig nificant difference at postoperative 3 and 6 months （ P 〉 0.05 ）. Conclusion The clinical efficacy of both PTED and chemonucleolysis in the treatment of single segment lumbar disc herniation is satisfactory. However. PTED is obviously better than chemanucleolvsis in terms of faster lumboerural pain relief.

关 键 词：腰椎间盘突出症 髓核溶解术 椎间孔镜 腰椎间盘切除术 

分 类 号：R681.5[医药卫生—骨科学]