C型臂引导下椎间孔镜直接神经根松解和减压术治疗腰椎间盘突出症伴神经根管狭窄患者的可行性与短期疗效  

The feasibility and short-term efficacy of C-arm guided intervertebral foramen endoscopic direct nerve root release and decompression in the treatment of lumbar disc herniation patients with nerve root canal stenosis

作　　者：周大勇 章辉 钟超 王卫松 Zhou Dayong;Zhang Hui;Zhong Chao;Wang Weisong(Department of Orthopaedics,Jining Combine Traditional Chinese and Western Medicine Hospital,Jining City,Shandong Province 272000,China)

机构地区：[1]济宁市中西医结合医院骨科,济宁市272000

出　　处：《中华疼痛学杂志》2023年第4期613-618,共6页Chinese Journal Of Painology

摘　　要：目的探讨CT引导下采用椎间孔入路脊柱内镜系统(TESSYS)手术治疗腰椎间盘突出症且伴有神经根管狭窄患者的可行性与短期疗效。方法收集2018年6月至2020年6月济宁市中西医结合医院骨科住院治疗的腰椎间盘突出症且伴有神经根管狭窄患者78例,以随机数字法分为开放手术组和TESSYS组,每组39例。对开放手术组患者采用常规术式治疗,TESSYS组患者采用椎间孔镜TESSYS术治疗。记录并比较两组患者手术出血量、手术时间和住院时间;评估并比较治疗前与治疗后3 d、1个月所有患者的疼痛视觉模拟评分(VAS),日本骨科协会(JOA)腰椎功能评分、Oswestry腰椎功能障碍指数(ODI)评分、疗效,并进行组间比较;观察并比较两组患者术后并发症的发生情况。结果一般资料比较无统计学差异且有可比性。与治疗前比较,治疗后3 d、1个月时,两组患者VAS评分、ODI评分均明显降低,JOA评分明显升高,差异均有统计学意义(P均<0.05)。与治疗后3 d比较,治疗后1个月两组患者VAS评分、ODI评分均更低,JOA评分、总有效率均更高差异均有统计学意义(P均<0.01)。与开放手术组比较,TESSYS组患者术中出血量更少,手术时间、住院时间更短,差异有统计学意义(t=9.43,13.36,17.66,P均<0.001);术后3 d、1个月TESSYS组患者VAS评分、ODI评分均更低,JOA评分均更高,差异均有统计学意义(P均<0.05)。术后3 d、1个月开放手术组患者的总有效率分别为64.1%(25/39例)、76.9%(30/39例),均明显低于TESSYS组总有效率82.0%(31/39例)、94.9%(37/39例),差异均有统计学意义(P均<0.05)。与开放手术组比较,TESSYS组无并发症发生,差异有统计学意义(P<0.05)。结论与开放手术相比,CT引导下椎间孔镜TESSYS术治疗腰椎间盘突出症且伴有神经根管狭窄患者安全可行且短期疗效显著。Objective To explore the feasibility and short-term efficacy of C-arm guided intervertebral foramen endoscopic direct nerve root release and decompression in the treatment of lumbar disc herniation with nerve root canal stenosis.Methods From June 2018 to June 2020,78 patients with lumbar disc herniation and nerve root canal stenosis in the Department of Orthopaedics in Jining Combine Traditional Chinese and Western Medicine Hospital,were collected,and randomly divided into open surgery group and TESSYS group,with 39 cases in each group.The patients in the open surgery group were treated with conventional surgery,and TESSYS group were treated with intervertebral foramen endoscopic TESSYS.The surgical bleeding volume,surgical time,and hospital stay between the two groups were recorded and compared.Visual analogue scale(VAS),Japanese Orthopedic Association(JOA)lumbar function score,Oswestry disability index(ODI)score,and efficacy of all patients were evaluated and compared before and 3 days and 1 month after the treatment.The incidence of postoperative complications were observed and compared.Results Compared with before the treatment,the VAS and ODI score were significantly reduced,and the JOA score was significantly increased at 3 days and 1 month after the treatment in the two groups(all P<0.05).VAS and ODI score were better at 1 month than that at 3 days after the treatment(all P<0.05).Compared with the open surgery group,the TESSYS group had less intraoperative bleeding,shorter surgical and hospitalization times(t=9.43,13.36,17.66,all P<0.001),and the TESSYS group had lower VAS and ODI scores,and higher JOA scores at 3 days and 1 month after the treatment than that in open surgery group(all P<0.05).The total effective rates were 64.1%(25/39 cases)and 76.9%(30/39 cases)at 3 days and 1 month after surgery respectively in the open surgery group,which were significantly lower than that in the TESSYS group 82.0%(31/39 cases)and 94.9%(37/39 cases)respectively(all P<0.05).No complications happened in the TESSYS group.

关 键 词：腰椎间盘突出症 神经根管狭窄 椎间孔镜TESSYS术 疼痛 麻木 腰痛 

分 类 号：R687.3[医药卫生—骨科学]