经皮椎间孔镜辅助精准治疗腰椎间盘突出合并椎体后缘离断症患者的临床疗效  

Clinical efficacy of percutaneous transforaminal endoscopic adjuvant precise therapy for patients with lumbar disc herniation and concomitant posterior apophyseal ring separation

作　　者：黄民锋[1] 黄中飞[1] 刘晓曦 刘万祥[1] 刘汝专[1] 潘汉升[1] 张鸿升 李枝发 HUANG Minfeng;HUANG Zhongfei;LIU Xiaoxi;LIU Wanxiang;LIU Ruzhuan;PAN Hansheng;ZHANG Hongsheng;LI Zhifa(Department of Spinal Surgery,Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine,Nanning 530011,Guangxi,China)

机构地区：[1]广西中医药大学附属瑞康医院脊柱外科,广西南宁市530011

出　　处：《广西医学》2023年第11期1269-1272,1286,共5页Guangxi Medical Journal

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170743);广西壮族自治区中医药管理局自筹经费科研课题(GZZC2020067)。

摘　　要：目的探讨经皮椎间孔镜辅助精准治疗腰椎间盘突出(LDH)合并椎体后缘离断症(PARS)患者的临床疗效。方法回顾性分析采用经皮椎间孔镜治疗的60例LDH合并PARS患者的临床资料。比较手术前后患者的腰痛视觉模拟量表(VAS)评分、腿痛VAS评分、腰椎日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)、相应手术节段椎管矢状径及患肢直腿抬高活动度。末次随访时,采用改良Macnab疗效评定标准进行疗效评价。结果与术前相比,术后即刻、术后3个月及末次随访时患者的腰痛VAS评分、腿痛VAS评分、ODI降低,腰椎JOA评分均升高(均P<0.05);与术后即刻相比,术后3个月、末次随访时患者的腰痛VAS评分、腿痛VAS评分、ODI降低,腰椎JOA评分均升高(均P<0.05)。末次随访时,患者疗效优良率达90.0%。与术前相比,术后第1天相应手术节段椎管矢状径及患肢直腿抬高活动度均增大(P<0.05)。结论经皮椎间孔镜辅助精准治疗LDH合并PARS患者的疗效确切,能有效缓解患者腰痛、腿痛,改善患肢活动度,促进患者术后康复,值得临床应用推广。Objective To explore the clinical efficacy of percutaneous transforaminal endoscopic adjuvant precise therapy for patients with lumbar disc herniation(LDH)and concomitant posterior apophyseal ring separation(PARS).Methods The clinical data of 60 patients with LDH and concomitant PARS undergoing percutaneous transforaminal endoscopic therapy were retrospectively analyzed.The pre-and postoperative Visual Analogue Scale(VAS)score for lumbago,VAS score for leg pain,Japanese Orthopedic Association(JOA)score for lumbar vertebra,Oswestry disability index(ODI),vertebral canal sagittal diameter of corresponding surgical segment,and straight legs raise activity of affected extremity were compared between patients.The efficacy evaluation was performed by the modified Macnab efficacy evaluation standard at the last follow-up.Results Compared with before operation,the VAS scores for lumbago and leg pain,and ODI in patients were decreased,while JOA score for lumbar vertebra in patients was elevated immediately after operation,3 months after operation,and at the last follow-up(all P<0.05).Compared with immediately after operation,the VAS scores for lumbago and leg pain,and ODI were decreased in patients,whereas JOA score for lumbar vertebra was elevated in patients 3 months after operation and at the last follow-up(all P<0.05).At the last follow-up,the excellent and favorable rate of efficacy in patients reached 90.0%.Compared with before operation,the vertebral canal sagittal diameter of corresponding surgical segment and straight legs raise activity of affected extremity were enlarged on the first day after operation(all P<0.05).Conclusion Percutaneous transforaminal endoscopic adjuvant precise therapy for patients with LDH and concomitant PARS exerts a definite efficacy,which can effectively relieve patients′lumbago and leg pain,ameliorate activity of affected extremity,promote patients′postoperative recovery,and it is worthy of application and promotion.

关 键 词：腰椎间盘突出症 椎体后缘离断症 经皮椎间孔镜 精准治疗 疼痛 疗效 

分 类 号：R681.5[医药卫生—骨科学]