腰椎间盘突出症阶梯式手术治疗方案的临床疗效和患者心理状况调查  

Investigation on Clinical Efficacy and Patient Satisfaction of Step Operation Treatment for Lumbar Disc Herniation

作　　者：王居勇[1] 王居强[2] 王华 王宝宝[1] 刘征宇[1] 彭建光[1] 张庆明[1] 鲁世保[1] 

机构地区：[1]首都医科大学宣武医院骨科,北京100053 [2]中国医科大学附属第一医院骨科,辽宁沈阳110001 [3]北京黎明医院妇产科,北京100011

出　　处：《现代生物医学进展》2016年第28期5444-5447,5535,共5页Progress in Modern Biomedicine

基　　金：北京自然科学基金项目(3112012)

摘　　要：目的:探讨阶梯式手术治疗方案对腰椎间盘突出的临床疗效和患者对临床疗效的心理接受情况。方法:回顾性分析2014年至2016年本院骨科确诊为腰椎间盘突出症的50例患者,经椎间孔镜下行髓核摘除微创手术(Percutaneous transforaminal endoscopic discectomy,PTED),术后1天和3个月采用视觉疼痛模拟评分(VAS)和改良Mac Nab疗效评定、术后3个月采用Oswestry功能障碍指数(ODI)评价手术效果,以及相应调查时间点患者对手术效果心理接受程度调查;对于7例微创手术疗效不佳患者进一步采用传统的开窗髓核摘除术(Fenestration discectomy,FD),采用同样方法评价手术效果和调查患者心理接受情况。结果:50例微创术后1天及术后3个月的VAS评分和ODI指数均显著低于术前,差异具有显著性(P均<0.05);改良Mac Nab疗效评定:术后1天优良率为84%,术后3个月为86%;患者对术后疗效心理满意度调查:术后1天,满意并接受为84%,不满意但接受为16%,不满意难接受为0;术后3个月,满意并接受为86%,不满意但接受为14%,不满意难接受为0。对于微创术后效果欠佳7例患者行FD手术,术后1天及3个月的VAS评分和ODI指数均显著低于术前,差异具有显著性(P均<0.05);改良Mac Nab疗效评定:术后1天优良率为71%,术后3个月为100%;患者对开窗术后疗效心理满意度调查:术后1天,满意并接受为71%,不满意但接受为0,不满意难接受为29%;术后3个月,满意并接受为100%,不满意但接受为0,不满意难接受为0。结论:腰椎间盘突出症阶梯式手术治疗方案临床效果和患者心理接受情况均值得临床推荐。Objective： To study the clinical efficacy and psychological acceptance of patients with lumbar disc herniation by step operation treatment. Methods： 50 patients with lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy （PTED） from 2014 to 2016 in our hospital, The visual analogue scale （VAS）, Oswestry Disability Index （ODI） and the modified MacNab criteria were used to measure the clinical outcomes at 1 day and 3 months after surgery, the psychological acceptance of the patients with the corresponding survey time point was Investigated. The 7 patients of poor clinical efficacy after minimally invasive surgery were to further treated with fenestration discectomy （FD）, the clinical outcomes and the psychological acceptance of the patients were performed with the same ways. Results： At 1 day and 3 months after minimally invasive surgery, The postoperative VAS scores, ODI were significantly improved when compared with the preoperative ones （P〈0.05）. The excellent and good rate was 84 % and 86 % at postoperative 1 day and 3 months time point according to the modified MacNab criteria. The psychological acceptance of the patients with the corresponding survey time point： 1 day after surgery, satisfaction and accept is 84 %, dissatisfied but accept is 16 %, dissatisfied with difficult to accept is 0; 3 months after surgery, satisfaction and accept is 86 %, dissatisfied but accept is 14 %, dissatisfied with difficult to accept is 0. The 7 patients further treated with fenestration discectomy （FD）. The postoperative VAS scores, ODI at 1 day and 3 months after surgery were also significantly improved （P〈0.05）. The excellent and good rate was 71% and 100 % at postoperative 1 day and 3 months time point according to the modified MacNab criteria. The psychological acceptance of the patients with the corresponding survey time point： 1 day after surgery, satisfaction and accept is 71%, dissatisfied but accept is 0, dissatisfied with difficult to acce

关 键 词：腰椎间盘突出 内窥镜技术 最小侵入性 开窗髓核摘除术 心理调查 

分 类 号：R681.53[医药卫生—骨科学] R687[医药卫生—外科学]