诱发性椎间盘造影联合完全可视经皮内窥镜技术诊治盘源性腰痛的价值  

Clinical value of provocative discography combined with fully visible percutaneous endoscopic surgery in the diagnosis and treatment of discogenic low back pain

作　　者：席志鹏[1] 李敬池 康然[1] 张仕兵[1] 谢林[1] Xi Zhipeng;Li Jingchi;Kang Ran;Zhang Shibing;Xie Lin(Department of Orthopaedics,Jiangsu Province Hospital on Integration of Chinese and Western Medicine,Nanjing 210028,China)

机构地区：[1]江苏省中西医结合医院骨科

出　　处：《中华诊断学电子杂志》2019年第4期239-243,共5页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：江苏省中医药领军人才项目(SLJ0210);江苏省卫生计生委科研项目(BJ16026)

摘　　要：目的探讨椎间盘源性腰痛的诊断方法并分析诱发性椎间盘造影联合完全可视内窥镜技术诊治盘源性腰痛的临床效果。方法回顾性分析2015年7月至2018年6月江苏省中西医结合医院骨科收治的29例通过诱发性椎间盘造影检查诊断为椎间盘源性腰痛患者的临床资料,该组患者全部应用完全可视内窥镜技术行髓核摘除、双极射频纤维环成形治疗。术前和术后1 d、3个月、6个月随访时对患者腰痛进行视觉模拟评分(VAS),对腰椎功能采用Oswestry功能障碍指数(ODI)评估,采用改良MacNab标准评价疗效。结果29例患者均成功实施手术,术后1 d、3个月、6个月VAS评分[(1.53±0.43)分,(1.06±0.61)分,(0.71±0.37)分]与术前VAS评分[(6.62±1.01)分]比较,均逐渐下降,差异有统计学意义(F=132.13,P<0.05);术后1 d、3个月、6个月ODI评分[(14.12±1.43)分,(12.98±2.01)分,(10.33±1.46)分]与术前ODI评分[(51.11±10.15)分]比较,均逐渐下降,差异有统计学意义(F=293.35,P<0.05);术后6个月时根据改良MacNab评分标准:优22例,良5例,可2例,差0例,术后优良率为93.10%(27/29)。结论诱发性椎间盘造影联合完全可视内窥镜技术诊治盘源性腰痛疗效好、安全性高,手术风险小,并发症少。Objective To explore the diagnostic methods and analyse the clinical effect of provocative discography combined with fully visible percutaneous endoscopic surgery of discogenic low back pain(DLBP).Methods The clinical data of 29 patients diagnosed with DLBP by provocative discography admitted to the department of orthopedics of Jiangsu Province Hospital on Integration of Chinese and Western Medicine from July 2015 to June 2018 were retrospectively analyzed.The patients underwent a fully visible percutaneous endoscopic procedure(disectomy and bipolar annuloplasty).The Visual Analog Scale(VAS)score and Oswestry Disability Index(ODI)score(preoperative,postoperative 1 day,3 months,6 months)were evaluated.The clinical global outcomes were assessed on the basis of modified MacNab criteria.Results All patients were successfully performed the operation.VAS significantly declined from preoperative(6.62±1.01)to postoperative 1 day(1.53±0.43),3 months(1.06±0.61)and 6 months(0.71±0.37)(F=132.13,P<0.05).ODI decreased from preoperative(51.11±10.15)to 1 day(14.12±1.43),3 months(12.98±2.01)and 6 months(10.33±1.46)(F=293.35,P<0.05).At the last follow-up,22 cases of the MacNab results were excellent,5 cases were good,2 cases were fair,and none was bad,and the excellent-to-good rate was 93.10%(27/29).Conclusion With fewer complications and a lower risk,provocative discography combined with fully visible percutaneous endoscopic surgery is safe and efficacious in the treatment of DLBP.

关 键 词：椎间盘源性腰痛 椎间盘造影 内窥镜 

分 类 号：R68[医药卫生—骨科学]