后正中小切口经双侧肌间入路开窗髓核摘除术在腰椎间盘突出症中的应用  

Application of fenestration discectomy via posterior median small incision and bilateral intermuscular approach in lumbar disc herniation

作　　者：康银辉 张彦祥[1] 王文亮[1] 谢亮 拓万宝 葛郁龙 张进[2] 高博 KANG Yin-hui;ZHANG Yan-xiang;WANG Wen-liang;XIE Liang;TUO Wan-bao;GE Yu-long;ZHANG Jin;GAO Bo(The Second Department of Orthopedics,Baoji People's Hospital,Baoji 721000,Shaanxi,CHINA;Department of Endocrinology,Baoji People's Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市人民医院骨二科,陕西宝鸡721000 [2]宝鸡市人民医院内分泌科,陕西宝鸡721000

出　　处：《海南医学》2023年第16期2331-2335,共5页Hainan Medical Journal

基　　金：陕西省科学技术研究发展计划(编号:2016SF-217)。

摘　　要：目的探究后正中小切口经双侧肌间入路Dynesys植入开窗髓核摘除术在腰椎间盘突出症中的应用效果。方法按随机数表法将2019年2月至2021年12月于宝鸡市人民医院接受治疗的86例腰椎间盘突出症患者分为对照组和观察组各43例。对照组患者采用常规显露Dynesys植入开窗髓核摘除术治疗,观察组患者采用后正中小切口经双侧肌间入路Dynesys植入开窗髓核摘除术治疗,比较两组患者的围术期情况,术前、术后3个月与末次随访(术后1年)的腰腿部视觉模拟评分(VAS)、Oswrestry功能障碍指数(ODI)、日本整形外科协会腰椎评分(JOA)、节段活动度及相关并发症发生情况。结果对照组患者有3例脱落,最终纳入40例。观察组患者的切口长度、术中失血量、手术时长、术后引流量分别为(5.82±0.93)cm、(91.39±23.15)mL、(93.46±21.35)min、(55.29±17.36)mL,明显短(少)于对照组的(9.81±0.88)cm、(181.92±43.46)mL、(124.75±25.66)min、(154.39±35.22)mL,差异均有统计学意义(P<0.05);观察组患者术后3个月时的腰部VAS评分、末次随访时的腿部VAS评分分别为(2.56±0.78)分、(0.89±0.06)分,明显低于对照组的(3.16±1.66)分、(1.12±0.35)分,差异均有统计学意义(P<0.05);观察组患者术后3个月、末次随访时的ODI评分分别为(16.83±3.42)分、(12.55±1.83)分,明显低于对照组的(20.63±5.72)分、(18.24±1.16)分,差异均有统计学意义(P<0.05);两组患者术后3个月、末次随访时的手术节段活动度、邻近节段活动度、手术节段间隙高度比较差异均无统计学意义(P>0.05);观察组患者的术后并发症总发生率为6.98%,略低于对照组的12.50%,但差异无统计学意义(P>0.05)。结论后正中小切口经双侧肌间入路与常规显露Dynesys植入开窗髓核摘除术治疗腰椎间盘突出症对患者腰椎节段活动度的改善作用相当,但后正中小切口经双侧肌间入路开展手术患者术后疼痛更轻、腰椎功能改�Objective To investigate the application effect of Dynesys implantation and fenestration discectomy via posterior median small incision and bilateral intermuscular approach in lumbar disc herniation.Methods A total of 83 patients with lumbar disc herniation who were treated in Baoji People's Hospital from February 2019 to December 2021 were divided into the control group and the observation group by random number table method,with 43 patients in each group.Patients in the control group were treated with conventional Dynesys implantation and fenestration discectomy,while patients in the observation group were treated with Dynesys implantation and fenestration discectomy via posterior median small incision and bilateral intermuscular approach.The two groups were compared in terms of perioperative conditions,the Visual Analogue Scale(VAS)scores of lower back and legs,Oswrestry Disability Index(ODI)scores,lumbar spine score(Japanese Orthopaedic Association,JOA),segment mobility before operation,at 3 months after operation and at the last follow-up(1 year after operation),and the incidence of related complications.Results Three patients in the control group dropped out,and finally 40 cases were included.The length of incision,intraoperative blood loss,operation time,and postoperative drainage volume in the observation group were(5.82±0.93)cm,(91.39±23.15)mL,(93.46±21.35)min,and(55.29±17.36)mL,significantly shorter/less than(9.81±0.88)cm,(181.92±43.46)mL,(124.75±25.66)min,and(154.39±35.22)mL in the control group(P<0.05).The waist VAS score at 3 months after operation and the leg VAS score at the last follow-up in the observation group were(2.56±0.78)points and(0.89±0.06)points,significantly lower than(3.16±1.66)points and(1.12±0.35)points in the control group(P<0.05).At 3 months after operation and at the last follow-up,the DOI scores of the observation group were(16.83±3.42)points and(12.55±1.83)points,significantly lower than(20.63±5.72)points and(18.24±1.16)points of the control group(P<0.05).There w

关 键 词：腰椎间盘突出症 双侧肌间入路 Dynesys植入开窗髓核摘除 疗效 

分 类 号：R681.53[医药卫生—骨科学]