富血小板血浆在经皮内镜椎间盘切除术的应用  

Effect of platelet-rich plasma on outcomes of percutaneous transforaminal endoscopic discectomy

作　　者：林正坚 邓高鹏 侯平 王斌 邱勋永[2] LIN Zheng-jian;DENG Gao-peng;HOU Ping;WANG Bin;QIU Xun-yong(Department of Orthopedics,The Third People's Hospital of Haikou City,Haikou 571100,China;Department of Microsurgery,Hainan Provincial People's Hospital,Haikou570311,China)

机构地区：[1]海口市第三人民医院骨科,海南海口571100 [2]海南省人民医院显微手外科,海南海口570311

出　　处：《中国矫形外科杂志》2022年第19期1750-1755,共6页Orthopedic Journal of China

摘　　要：[目的]分析经皮椎间孔镜椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)中注射富血小板血浆(platelet rich plasma,PRP)对临床疗效的影响。[方法]2019年1月—2019年12采用PTED治疗单纯腰椎间盘突出症患者73例。依据术前医患沟通结果,PRP组36例,手术结束时椎间盘内及神经根周围注射PRP液5 ml+凝血酶溶液2 ml(40 U/ml);无PRP组37例,仅行单纯PTED术。比较两组围术期、随访和影像资料。[结果]所有患者均顺利完成手术,两组术中并发症发生率比较差异无统计学意义(P=0.071)。两组手术时间、切口总长度、术中失血量、下地行走时间、切口愈合等级、住院时间及VAS评分的差异均无统计学意义(P>0.05)。两组患者平均随访时间(15.37±1.92)个月,随时间推移,两组VAS评分、ODI评分均显著降低(P<0.05);术后1个月PRP组VAS评分显著优于无PRP组(P<0.05),术后6个月和末次随访时,PRP组的ODI评分显著优于无PRP组(P<0.05)。影像方面,随时间推移,两组椎间隙高度指数均显著减少(P<0.05)。末次随访时PRP组的椎间隙高度指数显著优于无PRP组(P<0.05)。随时间推移,两组手术间隙Pfirrmann分级无显著变化(P>0.05)。末次随访时PRP组椎间盘Pfirrmann分级显著优于无PRP组(P<0.05)。[结论]PTED术中注射PRP可能有利于纤维环的修复,延缓椎间隙退变,改善临床治疗效果。[Objective]To explore the effect of platelet-rich plasma(PRP)in percutaneous transforaminal endoscopic discectomy(PT⁃ED)on clinical outcomes.[Methods]From January 2019 to December 2019,73 patients underwent PTED fro simple lumbar disc hernia⁃tion.According to the preoperative doctor-patient communication results,36 patients in PRP group were injected PRP 5ml combined with thrombin 2ml(40 U/ml)in intervertebral disc and around nerve roots at the end of surgery,while the other 37 patients in the non-PRP group had PTED performed alone.The Perioperative,follow-up and imaging data of the two groups were compared.[Results]All the pa⁃tients in both groups were successfully operated on,without significant difference in the incidence of intraoperative complications between the two groups(P=0.071).There were no significant differences in operative time,total incision length,intraoperative blood loss,postoper⁃ative walking time,incision healing,hospital stay and early VAS score between 2 groups(P>0.05).With time of follow-up lasted for(15.37±1.92)months,the VAS and ODI scores decreased significantly in both group(P<0.05).However,the PRP group proved signifi⁃cantly superior to the non-PRP group in VAS score 1 month postoperatively(P<0.05),and the ODI score at 6 months and the last followup(P<0.05).Radiographically,the intervertebral height index decreased significantly over time in both groups(P<0.05),which in the PRP group was significantly superior to the non-PRP group at the last follow-up(P<0.05).No significant change was noted over time in term of Pfirrmann classification for disc degeneration between two groups(P>0.05).At the latest follow-up,the PRP group proved signifi⁃cantly superior to the non-PRP group in term of Pfirrmann grading of intervertebral discs degeneration(P<0.05).[Conclusion]Intraopera⁃tive injection of PRP in PTED might be beneficial to the repair of annulus fibrosus,delay intervertebral degeneration and improve clinical outcomes.

关 键 词：腰椎间盘突出症 经皮椎间孔镜椎间盘切除术 富血小板血浆 椎间退变 

分 类 号：R681.53[医药卫生—骨科学]