经皮脊柱内镜椎间孔扩大成形术治疗腰椎间盘突出症的对比性研究  

Comparisons of a 2-year follow-up of transforaminal percutaneous endoscopic lumbar discectomy with or without foraminoplasty for lumbar disc herniation

作　　者：张绍波[1,2] 楼娅妮[1,3] 杨蕴华 金家琰 张钰扬 吴辛娜 占恭豪 ZHANG Shao-Bo;LOU Ya-Ni;YANG Yun-Hua;JIN Jia-Yan;ZHANG Yu-Yang;WU Xin-Na;ZHAN Gong-Hao(Department of Pain Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China;Department of Pain Medicine,the Hospital of Integrated Traditional and Western Medicine,Taizhou 317500,China;Department of Anesthesiology,the Second Medical School of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院疼痛科,温州325027 [2]台州市中西医结合医院疼痛科,台州317500 [3]温州医科大学第二临床医学院麻醉学系,温州325000

出　　处：《中国疼痛医学杂志》2020年第9期675-679,共5页Chinese Journal of Pain Medicine

基　　金：浙江省医学会课题(2015ZYC-A28)。

摘　　要：目的:对比经皮脊柱内镜术中是否进行椎间孔扩大成形术对腰椎间盘突出症手术疗效和临床预后的影响。方法:本研究纳入140例在我科因腰椎间盘突出症接受经皮脊柱内镜手术治疗的病人,其中62例进行椎间孔扩大成形术(transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty group, PELF组)、78例未进行椎间孔成形(transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty, PELD组,即"漂移组")。记录病人年龄、性别、手术时间、并发症、住院天数等。所有病人术后随访2年,采用视觉模拟评分法(visual analogue scale, VAS)和Oswestry功能障碍指数(Oswestry disability index, ODI)分别评估病人术前、术后1天、术后7天、术后1月、术后3月、术后6月、术后1年和术后2年腰痛、下肢痛和生活质量,采用改良Macnab标准评估病人术后2年手术疗效。结果:两组病人年龄、性别构成、疼痛持续时间、手术时间、住院天数等均无显著差异(P> 0.05)。PELF和PELD组病人术后腰痛、下肢痛VAS评分和ODI指数较术前均显著降低(P<0.01),但各时间点两组间无统计学差异(P> 0.05)。PELF组中2例病人发生硬膜囊撕裂,PELD组中1例病人发生神经根损伤,两组手术并发症发生率无显著性差异(P> 0.05)。PELF组中6例、PELD组中3例病人失访,共有131例病人完成Macnab评估,两组病人手术满意率分别为87.5%和90.7%(P> 0.05)。结论:经皮脊柱内镜术中采用椎体扩大成形术和"漂移"穿刺法均为治疗腰椎间盘突出症安全、有效的方法。Objective:This study was to compare the safety and effectiveness between transforaminal percutaneous endoscopic lumbar discectomy with(PELF)or without foraminoplasty(PELD)for lumbar disc herniation(LDH)patients.Methods:Totally 140 LDH patients were recruited,and 62 patients accepted PELF(PELF group)and 78 patients accepted PELD(PELD group)for LDH treatment during.We recorded the basic information of age,gender,operation time,the duration of hospital stay,and complications of all recruited patients,and followed them up for 2 years.The low back and leg visual analogue scale(VAS)pain ratings and Oswestry disability index(ODI)were compared between the 2 groups before and after surgery.Modified Macnab criterion was used to estimate for all patients at the final visit(postoperative 2-year).Results:There was no significance in age,gender,operation time,hospital stay or incidence of complications between the two groups(P>0.05).Low back and leg VAS,and ODI scores were decreased in both groups after operation(P˂0.01),but there was not significant difference between the two groups over time(P>0.05).Two cases in the PELF group suffered dural tear,and 1 case in the PELD group suffered neural nerve injury.Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up.Thus,totally 131 patients completed Macnab evaluation.The satisfactory rate was reported as 87.5%in the PELF group and 90.7%in the PELD group(P>0.05).Conclusion:This study suggests that both PELF and PELD are safe and effective for LDH patients.

关 键 词：经皮脊柱内镜 腰椎间盘突出症 椎间孔成形 微创 

分 类 号：R687.3[医药卫生—骨科学]