不同术式治疗腰椎间盘突出症疗效及对腰背肌生物力学性能的影响  

Effects of different surgical methods on lumbar disc herniation and and its influence on the biomechanical properties of lumbar dorsal muscles

作　　者：江天蔚[1] 姚琦[1] 李志君[1] JIANG Tian-wei;YAO Qi;LI Zhi-jun(Department of Orthopedics,Dalian Second People s Hospital,Dalian 116019,Liaoning,China)

机构地区：[1]大连市第二人民医院骨科,辽宁大连116019

出　　处：《川北医学院学报》2022年第10期1276-1279,共4页Journal of North Sichuan Medical College

基　　金：辽宁省科学技术计划项目(2020-MS-336)。

摘　　要：目的:探讨单边双通道脊柱内镜技术(UBE)和椎板开窗椎间盘切除术治疗腰椎间盘突出症(LDH)的疗效及对腰背肌生物力学性能的影响。方法:选取94例接受手术治疗的LDH患者为研究对象,根据治疗方式不同分为开放组(n=45)和UBE组(n=49)。开放组患者行椎板开窗椎间盘切除术治疗;UBE组患者行UBE治疗。比较两组患者手术一般情况、手术前腰背肌生物力学性能(背部屈伸比、前降力距、平均功率),并根据腰腿痛视觉模拟(VAS)评分、Oswestry功能障碍指数(ODI)和MacNab标准评价临床疗效。结果:与开放组比较,UBE组患者手术时间短(P<0.05),术中出血量少(P<0.05),术后输血率低(P<0.05)。两组患者术后住院时间相比,差异无统计学意义(P>0.05)。术后,UBE组腰背屈伸比低于开放组(P<0.05);前降力距和平均功率高于开放组(P<0.05)。术后12个月,UBE组患者ODI低于开放组(P<0.05);两组患者VAS评分相比,差异无统计学意义(P>0.05)。UBE组患者优良率高于开放组(P<0.05)。结论:UBE技术治疗LDH患者能够有效减轻疼痛,改善腰椎生物力学性能和腰椎功能,临床疗效优于传统椎板开窗椎间盘切除术。Objective:To investigate the clinical efficacy of unilateral double channel spinal endoscopy(UBE)and laminectomy in the treatment of lumbar disc herniation(LDH)and its influence on the biomechanical properties of lumbar dorsal muscles.Methods:94 patients with LDH were collected and divided into open group(n=45)and UBE group(n=49)according to different treatment methods.Patients in the open group were treated with laminectomy and discectomy,patients in the UBE group were treated with UBE.The general conditions of the two groups were compared,and the biomechanical properties of low back muscles(back flexion extension ratio,anterior descending force distance and average power)were measured before operation.The clinical efficacy was evaluated according to visual analogue of low back and leg pain(VAS),Oswestry dysfunction index(ODI)and macnab criteria.Results:Compared with the open group,the operation time,intraoperative bleeding and postoperative blood transfusion rate in UBE group were significantly shorter(P<0.05).There was no significant difference in postoperative hospital stay between the two groups(P>0.05).After operation,the low back flexion extension ratio in UBE group was lower than that in open group(P<0.05),and the anterior descending force distance and average power were higher than those in open group(P<0.05).At 12 months of follow-up,ODI in UBE group was significantly lower than that in open group(P<0.05),and there was no significant difference in VAS score between the two groups(P>0.05).The excellent and good rate in UBE group was higher than that in open group(P<0.05).Conclusion:UBE technology can effectively reduce pain and improve lumbar biomechanical properties and lumbar function in patients with LDH.The clinical effect is better than traditional laminectomy.

关 键 词：腰椎间盘突出症 经皮椎间孔脊柱内镜技术 椎板开窗椎间盘切除术 疗效 

分 类 号：R681.5[医药卫生—骨科学]