克氏针引导的镜外环锯技术与经皮椎间孔镜技术治疗腰椎间盘突出症的临床疗效比较  

Clinical efficacy of transforaminal Kirschner-wire guided endoscopic external trephination versus transforaminal endoscopic spine system in treatment of lumbar disc herniation

作　　者：范新成[1] 常斌 伊超凡 赵伟[1] 彭国庆[1] 刘益雷 王震[1] 刘峰[1] Fan Xincheng;Chang Bin;Yi Chaofan;Zhao Wei;Peng Guoqing;Liu Yilei;Wang Zhen;Liu Feng(Department of Spinal Surgery,Central Hospital of Tai′an City,Tai′an 271000,China;Shandong First Medical University,Tai′an 271000,China)

机构地区：[1]泰安市中心医院脊柱外科,271000 [2]山东第一医科大学(山东省医学科学院),山东泰安271000

出　　处：《中华临床医师杂志（电子版）》2019年第11期811-816,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：椎间孔镜关键技术的标准化流程研究(2017NS0193)

摘　　要：目的观察克氏针引导的镜外环锯技术(ET技术)和传统的经皮椎间孔镜技术(TESSYS技术)治疗腰椎间盘突出症的临床疗效,并对比两者之间差异。方法回顾性分析自2016年1月至2018年12月在泰安市中心医院脊柱外科接受经皮椎间孔镜治疗且在术中需要行腰椎间孔成形术的107例单节段腰椎间盘突出患者的临床资料,其中采用TESSYS技术治疗的59例患者为TESSYS技术组,采用ET技术治疗的48例患者为ET技术组,采用t检验比较2组患者术中透视次数、手术时间以及术后48 h、3个月、6个月的疼痛视觉模拟量表(VAS)评分和功能障碍指数(ODI)评分的差异。结果 2组患者均顺利完成手术。ET技术组术中平均透视次数和平均手术时间均少于TESSYS技术组[(11.9±1.8)次vs(16.3±2.4)次;(64.8±5.6)min vs(82.3±7.2)min],差异均具有统计学意义(t=10.518、13.782,P均<0.001)。107例患者术后均随访6个月。2组患者术后48 h、3个月、6个月的ODI评分及VAS评分较术前改善,各时间段ODI评分及VAS评分比较,差异均无统计学意义(P> 0.05)。结论 TESSYS技术与ET技术治疗腰椎间盘突出症均能取得较为理想的临床疗效,而ET技术手术操作更简单、手术时间更短、透视次数更少、患者耐受性更好。Objective To compare the efficacy of transforaminal Kirschner-wire guided endoscopic external trephination(ET) versus the transforaminal endoscopic spine system(TESSYS) in the treatment of lumbar disc herniation(LDH). Methods From January 2016 to December 2018, a retrospective analysis was carried out on 107 patients with LDH who underwent TESSYS or ET treatment. The patients were divided into either a TESSYS group(59 cases) or an ET group(48 cases). The t-test was used to compare the number of intraoperative fluoroscopies, operation duration, and visual analogue scale(VAS) and Oswestry disability index(ODI) scores at 48 h, 3 months, and 6 months after surgery between the two groups. Results All surgeries were carried out successfully. The average number of intraoperative fluoroscopies and mean operation time were significantly less in the ET group than in TESSYS group [(11.9±1.8) times vs(16.3±2.4) times, t=10.518, P < 0.001;(64.8±5.6) min vs(82.3±7.2) min, t=13.782, P < 0.001]. All of the 107 cases were followed for at least 6 months after surgery. The VAS and ODI scores at postoperative 48 h, 3 months, and 6 months in both groups were all significantly lower than the preoperative scores, but the VAS and ODI scores between different postoperative time points(48 h, 3 months, and 6 months) were not significantly different(P > 0.05). Conclusion Both TESSYS and ET can achieve good clinical efficacy in the treatment of LDH. ET has a simpler operative procedure, shorter operation time, and fewer fluoroscopies than TESSYS.

关 键 词：椎间盘移位 TESSYS技术 ET技术 内窥镜 

分 类 号：R687.3[医药卫生—骨科学]