经皮椎间孔镜腰椎间盘摘除术治疗腰椎间盘突出的前瞻性研究  

A prospective study of percutaneous endoscopic lumbar discectomy for lumbar disc herniation

作　　者：米盼盼[1] 陈胜乐[1] 许雅芳[2] 樊国峰[1] MI Pan-pan;CHEN Sheng-le;XU Ya-fang(Department of Orthopaedics, 2 Department of Radiology, China National Petroleum Corporation Center Hospital, Langfang Hebei 065000,China.)

机构地区：[1]中国石油天然气集团公司中心医院骨科,河北廊坊065000 [2]中国石油天然气集团公司中心医院影像科,河北廊坊065000

出　　处：《临床和实验医学杂志》2018年第20期2217-2220,共4页Journal of Clinical and Experimental Medicine

基　　金：廊坊市科学技术局项目(编号:2017013053)

摘　　要：目的探讨经皮椎间孔镜腰椎间盘摘除术治疗腰椎间盘突出的临床价值。方法前瞻性选取96例腰椎间盘突出症患者,随机分为观察组与对照组,各48例。观察组行经皮椎间孔镜腰椎间盘摘除术,对照组行Quadrant通道辅助微创经椎间孔腰椎融合术。比较两组手术时间、术中出血量、住院时间、手术前后的腰腿痛程度[应用视觉模拟评分(VAS)评估]、腰椎功能[(用日本骨科协会评估治疗分数(JOA)评分^([4])与Oswestry功能障碍指数(ODI)评估)]、并发症总发生率及术后12个月的优良率。结果观察组手术时间、术中出血量、住院时间均显著低于对照组(P<0.05)。术后1周两组VAS评分均较术前显著减小(P<0.05),观察组术后1周的VAS评分显著低于对照组(P<0.05)。术后两组ODI指数均较术前显著减小、JOA评分较术前显著增大(P<0.05);观察组术后3个月、6个月的ODI指数均显著低于对照组,JOA评分显著高于对照组(P<0.05)。两组并发症总发生率与优良率的差异无统计学意义(P>0.05)。结论经皮椎间孔镜腰椎间盘摘除术治疗腰椎间盘突出具有手术创伤小、恢复快、对脊柱稳定性影响小的优点,患者腰腿痛缓解与腰椎功能恢复效果较经椎间孔腰椎融合术更佳,值得推广。Objective To evaluate the clinical value of percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation. Methods A total of 96 patients with lumbar disc herniation were randomly divided into observation group and control group, 48 cases in both group. The observation group was treated with percutaneous endoscopic lumbar discectomy, and the control group was treated with minimally invasive lumnar interbody fusion under the Quadrant system. The operation time, intraoperative blood loss, hospitalization time, low back pain （assessed using VAS score） and lumbar function （assessed by JOA score and ODI index） before operation and after operation, the overall incidence of complications and excellent rate at 12 months after operation were compared between two groups. Results The operation time, intraoperative blood loss, hospitalization time of observation group were significantly lower than those in control group （ P 〈0.05）. The VAS scores of the two groups were significantly lower than those before surgery （ P 〈0.05）, and the VAS scores of the observation group were significantly lower than those of the control group （ P 〈0.05）. The ODI index of the two groups decreased significantly after surgery, and the JOA score significantly increased compared with before operation （ P 〈0.05）. The ODI index of the observation group at 3 months and 6 months after operation was significantly lower than that of the control group. JOA The score was significantly higher than the control group （ P 〈0.05）. There was no significant difference in the incidence of total complications and good rates between the two groups （ P 〉0.05）. Conclusion The percutaneous endoscopic lumbar discectomy with lumbar disc herniation has the advantages of small surgical trauma, quick recovery and little effect on the stability of the spine, and the effect of lumbar and leg pain relief and lumbar vertebral function recovery is better, worthy of promotion.

关 键 词：腰椎间盘突出 经皮椎间孔镜腰椎间盘摘除术 经椎间孔腰椎融合术 

分 类 号：R687.3[医药卫生—骨科学]