可扩张脊柱微创通道下腰椎间盘突出症髓核摘除后纤维环裂口的缝合修复  

Clinical effectiveness of annulus repair after discectomy under Mast Quadrant system for lumbar disc herniation

作　　者：江新[1] 李峰[1] 潘海松[1] 霍雄涛[1] 肖强兵[1] 杨功旭[1] 

机构地区：[1]湖北省中医院骨伤科,湖北省武汉市430074

出　　处：《中国组织工程研究》2017年第24期3912-3917,共6页Chinese Journal of Tissue Engineering Research

基　　金：湖北省中医院科研课题资助项目(JDZX2014Q06)~~

摘　　要：背景:研究表明,腰椎间盘突出髓核摘除后行纤维环缝合可在获得良好疗效的同时降低复发率,但有效的修复方法及可靠的修复器械报道极少。目的:观察在可扩张脊柱微创通道下腰椎间盘突出症髓核摘除后进行纤维环裂口缝合修复的临床效果。方法:纳入2013年8月至2015年8月湖北省中医院收治的腰椎间盘突出症患者50例,随机分为2组,缝合组25例在髓核摘除后行纤维环缝合术,对照组25例单纯行髓核摘除术。记录并比较2组切口长度、手术时间、术中失血量,评估治疗前后Oswestry功能障碍评分(ODI)、腰痛及下肢痛的目测类比评分,同时观察手术并发症及复发情况。结果与结论:(1)缝合组25例患者获得完整随访,对照组只有23例完成随访;(2)2组患者性别、年龄及手术节段等相比差异无显著性意义(P>0.05);(3)2组目测类比评分及ODI术后各时间点与术前比较均明显降低(P<0.05)。2组间比较,除术后1个月的目测类比评分外,缝合组与对照组术前及术后ODI、目测类比评分比较差异均无显著性意义(P>0.05);(4)对照组2例复发,其中1例行再手术治疗,复发率9%;缝合组中1例复发,并未再次手术,复发率4%;(5)2组均未发生脑脊液漏、感染、神经根损伤等严重并发症;(6)综上,腰椎间盘摘除后同时行纤维环裂口缝合术创伤小,重建了椎间盘的完整结构,可有效防止髓核再突出,具有可行性与有效性,临床疗效满意。BACKGROUND： Anular repair after discectomy in intervertebral disc degeneration obtains good clinical outcomes and reduces the recurrent rate, but there is little report on the effective suturing method and reliable instrument. OBJECTIVE： To investigate the clinical effectiveness of annulus repair after discectomy under Mast Quadrant system for lumbar disc herniation. METHODS： Fifty patients with lumbar disc herniation admitted in the Hubei Provincial Hospital of TCM from August 2013 to August 2015 were selected, followed by divided into experimental and control groups （n=25 per group）, and then received annulus repair after discectomy and simple discectomy, respectively. The length of incision, operation time and intraoperative blood loss were compared between two groups, and the Oswestry disability index and visual analogue scale scores for lumbago and lower limb pain before and after surgery were detected, as well as the incidence of complications and recurrence were recorded. RESULTS AND CONCLUSION： All patients in the experimental group completed the follow-up, while only 23 in the control group finished the follow-up. There were no significant differences in the baseline data between two groups （P 〉 0.05）. The postoperative Oswestry disability index and visual analogue scale scores in both two grouPs were significantly lower than those before surgery （P 〈 0.05）. There was a significant difference in the visual analog scale score at 1 month postoperatively between two groups （P 〈 0.05）, while the scores at other time points showed insignificant difference between two groups （P 〉 0.05）. There were two cases of recurrence in the control group, one of which received secondary treatment, and the recurrent rate was 9%. In the experimental group, there was only one case of recurrence receiving no treatment, and the recurrent rate was 4%. There were no cerebrospinal fluid leakage, infection, never root injury or other serious complications in both two groups. These results indicat

关 键 词：腰椎 椎间盘移位 缝合技术 组织工程 组织构建 腰椎间盘突出症 椎间盘 髓核摘除 纤维环缝合 疗效 重建 生物学治疗 再生 微创手术 随访 

分 类 号：R318[医药卫生—生物医学工程]