经皮椎间孔镜腰椎间盘摘除手术不同手术入路治疗高度脱垂游离型腰椎间盘突出症的疗效比较  

Comparison of Curative Effects of Percutaneous Transforaminal Lumbar Discectomy with Different Surgical Approaches in the Treatment of Highly Prolapse Free Lumbar Disc Herniation

作　　者：林志勇[1] 肖隆艺 邓睿[1] 李希文 LIN Zhiyong;XIAO Longyi;DENG Rui;LI Xiwen(Department of Orthopedics,the Second People's Hospital of Foshan,Foshan,Guangdong Province,528000 China)

机构地区：[1]佛山市第二人民医院骨科,广东佛山528000

出　　处：《中外医疗》2022年第11期49-53,共5页China & Foreign Medical Treatment

摘　　要：目的探讨分析经皮椎间孔镜腰椎间盘摘除术不同手术入路在高度脱垂游离型腰椎间盘突出症治疗中的效果。方法随机选取2017年1月—2021年6月因高度脱垂游离型腰椎间盘突出症在该院行椎间盘摘除术的患者60例,按照随机数表法均分为观察组(30例)和对照组(30例),对照组患者以椎间孔入路(PETD)的方式行摘除术,观察组以椎板间入路(PEID)的方式行摘除术。比较两组患者手术相关指标、视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)评分及并发症发生情况,采取改良MacNab标准评价治疗效果。结果观察组治疗优良率(86.67%)高于对照组,但差异无统计学意义(χ^(2)=1.002,P=0.317);观察组手术用时为(61.79±16.21)min,明显短于对照组(72.45±17.24)min,差异有统计学意义(t=2.467,P=0.017);观察组术中透视次数为(8.15±4.91)次,明显少于对照组(25.73±9.12)次,差异有统计学意义(t=9.296,P<0.001);两组患者随访6个月后的VAS、ODI评分均明显低于治疗前,差异有统计学意义(P<0.05);6个月后,观察组和对照组的VAS、ODI评分比较差异无统计学意义(P>0.05);观察组患者的切口感染、硬膜损伤、复发、神经根痛觉过敏不良反应发生情况明显低于对照组,差异有统计学意义(P<0.05)。结论经皮椎间孔镜的两种手术入路方式均能有效改善高度脱垂游离型腰椎间盘突出症症状,具有安全、创伤小等优点,效果确切,但椎间板入路方式手术用时、透视次数及安全性明显优于椎间孔入路方式。Objective To discussion and analysis the therapeutic effect of different surgical approaches for percutaneous transforaminal lumbar discectomy in the treatment of highly prolapse free lumbar disc herniation.Methods From January 2017 to June 2021,60 patients who underwent intervertebral discectomy in the hospital due to high prolapse free lumbar disc herniation were randomly selected and randomly divided into observation group(30 cases)and the control group(30 cases),the control group underwent enucleation by intervertebral foraminal approach(PETD),and the observation group underwent enucleation by interlaminar approach(PEID).By comparing the operation-related indicators,VAS,ODI scores and complications of the two groups of patients,the modified MacNab standard was used to evaluate the treatment effect.Results The treatment excellent rate in the observation group(86.67%)was higher than that in the control group,but the difference was not statistically significant(χ^(2)=1.002,P=0.317);the operation time of the observation group(61.79±16.21)min was significantly shorter than that of the control group(72.45±17.24)min,the difference was statistically significant(t=2.467,P=0.017);the number of intraoperative fluoroscopy in the observation group(8.15±4.91)times was significantly less than that in the control group(25.73±9.12)times,the difference was statistically significant(t=9.296,P<0.001);after 6 months of follow-up,the VAS and ODI scores of the two groups were significantly lower than those before treatment,and the difference was statistically significant(P<0.05).After 6 months,there was no statistically significant difference in the VAS and ODI scores between the observation group and the control group(P>0.05).The incidence of adverse reactions such as incision infection,dural injury,recurrence,nerve root hyperalgesia in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The two surgical approaches of percutaneous tra

关 键 词：腰椎间盘突出症 高度脱垂游离型 经皮椎间孔镜 椎板间入路 椎间孔入路 

分 类 号：R4[医药卫生—临床医学]