椎间孔镜联合富血小板血浆治疗椎间盘源性腰痛  

Percutaneous transforaminal endoscopic discectomy combined with platelet-rich plasma for discogenic low back pain

作　　者：杜薇 丁宇[1] 崔洪鹏 张建军 李雯[1] 朱凯[1] 卢正操 DU Wei;DING Yu;CUI Hong-peng;ZHANG Jian-jun;LI Wen;ZHU Kai;LU Zheng-cao(Department of Traditional Chinese Orthopedics,TheSixth Medical Center,General Hospital of PLA,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心中医医学部骨伤科,北京100048

出　　处：《中国矫形外科杂志》2023年第10期887-891,共5页Orthopedic Journal of China

基　　金：首都临床诊疗技术研究及示范应用项目(编号:Z191100006619028);解放军总医院第六医学中心创新培育基金资助项目(编号:CXPY201920)。

摘　　要：[目的]观察椎间孔镜(percutaneous transforaminal endoscopy discectomy,PTED)联合富血小板血浆(platelet-rich plasma,PRP)治疗椎间盘源性腰痛(discogenic low back pain,DLBP)的临床疗效。[方法]将36例DLBP患者随机分为PRP组与非PRP组,每组18例,PRP组给予PTED联合PRP治疗,非PRP组给予单纯PTED手术治疗,比较两组围手术期、随访及影像结果。[结果]两组手术均顺利完成,两组手术时间、术中透视次数、术中失血量、住院时间的差异均无统计学意义(P>0.05),未出现严重不良反应及并发症。随访12个月以上,PRP组恢复完全负重活动显著早于非PRP组(P<0.05)。术后随时间推移,两组VAS评分、ODI指数均显著减少(P<0.05),而JOA评分显著增加(P<0.05);术前、术后3个月两组间上述评分的差异均无统计学意义(P>0.05),术后12个月,PRP组上述评分均显著优于非PRP组(P<0.05)。影像方面,术后12个月PRP组椎间隙高度及椎间盘Pfirrmann分级均显著优于非PRP组(P<0.05)。[结论]PTED联合PRP治疗DLBP安全有效,可有效缓解疼痛,并有一定的延缓间盘退变的作用。[Objective]To evaluate the clinical outcomes of percutaneous transforaminal endoscopic discectomy(PTED)combined with platelet-rich plasma(PRP)for discogenic low back pain(DLBP).[Methods]A total of 36 patients with DLBP were randomly divided into PRP group and non-PRP group with 18 cases in each group.The PRP group was treated with PTED combined with intradiscal injection of PRP,while the non-PRP group received PTED only.The perioperative,follow-up and imaging documents were compared between the two groups.[Results]All patients in both groups had corresponding surgical procedures performed smoothly without significant differences in terms of operation time,intraoperative fluoroscopy times,intraoperative blood loss and hospital stay between the two groups(P<0.05),without serious adverse reactions and complications in both groups.All of them were followed up for more than 12 months,and the PRP group resumed full weight-bearing activity significantly earlier than the non-PRP group(P<0.05).The VAS score for pain and ODI score significantly decreased(P<0.05),while JOA score significantly increased in both groups over time(P<0.05),which was not significantly different between the two groups before surgery and 3 months after surgery(P>0.05),while in the PRP group proved significantly superior to those in the non-PRP group at 12 months postoperatively(P<0.05).With respect of imaging,the PRP group also proved significantly superior to the non-PRP group in terms of the disc height and Pfirrmann grades of involved intervertebral space 12 months postoperatively(P<0.05).[Conclusion]PTED combined with PRP is a safe and effective method for the treatment of DLBP,which can effectively relieve pain and might delay intervertebral disc degeneration to a certain extent.

关 键 词：椎间盘源性腰痛 微创手术 椎间孔镜术 富血小板血浆 

分 类 号：R687[医药卫生—骨科学]