椎间孔镜神经根减压松解术与椎板间开窗髓核摘除术治疗单节段单侧腰椎间盘突出症的临床疗效比较  

Comparative study of the efficacy of foraminoscopic nerve root decompression and interlaminar fenestration for unilateral lumbar disc herniation

作　　者：薛祖军 黄鑫 王扬生 李骏 Zu-jun Xue;Xin Huang;Yang-sheng Wang;Jun Li(Department of Orthopaedics,Ningbo Yinzhou People’s Hospital,Ningbo,Zhejiang 315100,China)

机构地区：[1]宁波市鄞州人民医院骨科,浙江宁波315100

出　　处：《中国内镜杂志》2020年第5期61-67,共7页China Journal of Endoscopy

摘　　要：目的对比椎间孔镜神经根减压松解术与椎板间开窗髓核摘除术治疗单节段单侧腰椎间盘突出症(LDH)的临床疗效。方法使用随机数字表法将该院收治的98例单节段单侧LDH患者分为两组(每组各49例),A组行椎间孔镜神经根减压松解术,B组行椎板间开窗髓核摘除术。比较两组的手术情况、手术效果和腰痛改善情况等。结果A组手术时间较B组长,术中出血量明显比B组少,切口长度、下床活动时间、住院天数明显较B组更短(均P<0.05)。两组术后1 d、术后3个月和术后6个月的视觉模拟评分(VAS)均较术前明显降低,但组间差异无统计学意义(P>0.05)。两组术后6个月日本矫形外科协会评分(JOA)均较术前明显升高,术后3和6个月功能障碍指数问卷评分(ODI)较术前明显降低,且两组JOA评分和ODI指数比较,差异均无统计学意义(P>0.05)。A组和B组手术总有效率分别为95.92%和93.88%,组间比较,差异无统计学意义(P>0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论椎间孔镜神经根减压松解术与椎板间开窗髓核摘除术治疗单节段单侧LDH,疗效相当,但前者创伤更小、出血量更少、住院时间更短且患者术后恢复更快。Objective To compare the clinical efficacy of foraminoscopic nerve root decompression and nucleus pulposus enucleation with interlaminar fenestration in treatment of unilateral lumbar disc herniation(LDH).Methods 98 patients with unilateral LDH were divided into two groups by random number table method(n=49).Group A underwent foraminoscopic nerve root decompression and group B underwent interlaminar fenestration and nucleus pulposus enucleation.The operation condition,effect and improvement of low back pain were compared between the two groups.Results The operation time of group A was significantly longer than that of group B,the amount of bleeding during operation was significantly less than that of group B,and the length of incision,the time of getting out of bed and the days of hospitalization were significantly shorter than those of group B(P<0.05).The visual analogue score(VAS)of the two groups at 1 day,3 months and 6 months after operation was significantly lower than that before operation,and there was no significant difference between the two groups(P>0.05).The JOA score of the two groups was significantly higher than that of the preoperative,and the ODI score of the three and six months after operation was significantly lower than that of the preoperative.There was no significant difference between the two groups in JOA score and ODI index(P>0.05).There was no significant difference between the two groups(P>0.05).There was no significant difference between the two groups(P>0.05).Conclusion Endoscopic nerve root decompression and release is as effective as interlaminar fenestration for unilateral LDH,but the former has less trauma,less bleeding,shorter hospital stays and faster recovery after operation.

关 键 词：腰椎间盘突出症 神经根减压松解术 开窗髓核摘除术 微创 腰椎功能 

分 类 号：R681.5[医药卫生—骨科学]