经皮椎间孔镜髓核摘除术与胶原酶髓核溶解术治疗腰椎间盘突出症的疗效对比  

Comparison of curative effects of percutaneous interforaminal nucleus pulposus extraction and collagenase nucleolysis in the treatment of lumbar disc herniation

作　　者：贺奇志 周黎明 沈兴利 陈力 赵林 汤壮 朱文博 李星宇 HE Qizhi;ZHOU Liming;SHEN Xingli;CHEN Li;ZHAO Lin;TANG Zhuang;ZHU Wenbo;LI Xingyu(Pain Department,PLA 63680 Army Hospital,Wuxi 214431,Jiangsu,China)

机构地区：[1]中国人民解放军63680部队医院疼痛科,江苏无锡214431

出　　处：《右江医学》2023年第5期434-437,共4页Chinese Youjiang Medical Journal

摘　　要：目的 比较经皮椎间孔镜髓核摘除术与胶原酶髓核溶解术治疗腰椎间盘突出症的临床疗效。方法 选取2019年6月至2020年10月就诊的89名腰椎间盘突出症患者,根据患者接受的治疗方式分为经皮椎间孔镜组(n=43)和胶原酶髓核溶解术组(n=46)。采用视觉模拟疼痛评分法(visual catalogue score, VAS)分别对两组患者术后3天、2个月和6个月的腰痛或下肢痛进行评分,并在末次随访时采用改良MacNab疗效评定标准进行评价。结果 两组患者术后各随访时间点VAS评分较术前均有改善,差异有统计学意义(P<0.05);术后各随访时间点VAS评分经皮椎间孔镜组均低于胶原酶髓核溶解术组,且术后3天、2个月时两组VAS评分比较差异有统计学意义(P<0.05)。经皮椎间孔镜组与胶原酶髓核溶解术组末次随访改良MacNab疗效评定优良率分别为90.70%与84.78%,差异无统计学意义(P>0.05)。结论 经皮椎间孔镜髓核摘除术与胶原酶髓核溶解术均可有效治疗腰椎间盘突出症,但胶原酶髓核溶解术的早期疗效差于经皮椎间孔镜髓核摘除术。Objective To compare the clinical effects of percutaneous interforaminal nucleus pulposus extraction and collagenase nucleolysis in the treatment of lumbar disc herniation.Methods A total of 89 patients with lumbar disc herniation admitted to hospital from June 2019 to October 2020 were selected and divided into percutaneous endoscopic transforaminal discectomy group(n=43)and collagenase nucleolysis group(n=46)according to the treatment methods they received.Visual catalogue score(VAS)was used to score the lumbar or lower limb pain of patients in the two groups at 3 days,2 months and 6 months after surgery,respectively.In addition,modified MacNab efficacy evaluation standard was used to evaluate the clinical effect at the last follow-up visit.Results Compared with that before operation,the VAS score of the two groups at each follow-up time point after operation improved,and difference was statistically significant(P<0.05).VAS score of the percutaneous endoscopic transforaminal discectomy group was all lower that that of collagenase nucleolysis group at each follow-up time point after operation,the difference of the VAS scores between the two groups at 3 days and 2 months after operation was statistically significant(P<0.05).The excellent and good rates of the modified MacNab of the percutaneous endoscopic transforaminal discectomy group and the collagenase nucleolysis group at the last follow-up visit were 90.70%and 84.78%,respectively,and difference was not statistically significant(P>0.05).Conclusion Both percutaneous interforaminal nucleus pulposus extraction and collagenase nucleolysis are effective in the treatment of lumbar disc herniation,but the early curative effect of collagenase nucleolysis is inferior to that of percutaneous interforaminal nucleus pulposus extraction.

关 键 词：腰椎间盘突出症 椎间孔镜 胶原酶 疼痛 

分 类 号：R681.53[医药卫生—骨科学]