神经电生理监测辅助全麻与局麻下经皮脊柱内镜腰椎髓核摘除术比较  

Comparison of Percutaneous Endoscopic Lumbar Discectomy for Nucleus Pulposus Removal under General Anesthesia and Local Anesthesia Assisted by Neurophysiologic Monitoring

作　　者：林成 林世水[1] 林克凤[1] 刘国铭[1] 李建华[1] 高尚君 周仕国[1] LIN Cheng;LIN Shishui;LIN Kefeng;LIU Guoming;LI Jianhua;GAO Shangjun;ZHOU Shiguo(Department of Orthopedics,Provincial Clinical Medical College of Fujian Medical University(South Hospital of Fujian Provincial Hospital),Fuzhou,Fujian Province,350001 China)

机构地区：[1]福建医科大学省立临床医学院(福建省立医院南院)骨科,福建福州350001

出　　处：《中外医疗》2023年第24期5-9,共5页China & Foreign Medical Treatment

摘　　要：目的对比神经电生理监测辅助全麻与局麻两种不同麻醉方式下,经皮脊柱内镜下腰椎间盘髓核摘除术(percutaneous endoscopic lumbar discectomy,PELD)在治疗单节段腰椎间盘突出症患者中的临床疗效。方法回顾性分析2019年9月—2022年6月福建省立医院南院诊断为单节段腰椎间盘突出症并行PELD治疗的68例患者的临床资料,分为全麻+电生理组(36例)和局麻组(32例)。比较两组手术时间、术中出血量、神经根刺激次数及住院时间,术前、术后3 d及术后3个月视觉模拟评分(Visual Nalogue Scale,VAS)及术前、术后3个月的Oswestry功能障碍指数(Oswestry Disability Index,ODI)。结果全麻+电生理组与局麻组患者的术中出血量比较差异无统计学意义(P>0.05)。全麻+电生理组患者的手术时间(60.56±7.15)min短于局麻组,神经根刺激次数(0.39±0.59)次低于局麻组,住院时间(1.53±0.61)d长于局麻组,差异有统计学意义(t=4.846、3.120、2.593,P<0.05)。两组患者的术后3 d、术后3个月VAS评分及术后3个月ODI指数均较术前降低,差异有统计学意义(P<0.05)。两组患者各相同时间点VAS评分及ODI指数比较,差异无统计学意义(P>0.05)。结论神经电生理监测辅助全麻下行经皮脊柱内镜下腰椎间盘髓核摘除术与局麻下手术的疗效相近,全麻手术可改善患者的手术体验,神经电生理监测为全麻手术中避免神经根损伤提供了安全有效的保障。Objective To compare the clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)for nucleus pulposus removal in the treatment of patients with single-segment lumbar disc herniation under two different anesthesia modalities,general anesthesia and local anesthesia,assisted by neurophysiological monitoring.Methods The clinical data of 68 patients diagnosed with single-segment lumbar disc herniation and treated with PELD in the South Hospital of Fujian Provincial Hospital from September 2019 to June 2022 were retrospectively analyzed.The patients were divided into general anesthesia+electrophysiological group(36 cases)and local anesthesia group(32 cases).The operation time,intraoperative blood loss,number of nerve root stimulation and hospitalization time,Visual Nalogue Scale(VAS)before operation,3 days after operation and 3 months after operation were compared between the two groups.The Oswestry Disability Index(ODI)was measured before and 3 months after operation.Results There was no statistically significant difference in intraoperative blood loss between the general anesthesia+electrophysiological group and the local anesthesia group(P>0.05).The operation time(60.56±7.15)min of the general anesthesia+electrophysiology group was shorter than that of the local anesthesia group,the number of nerve root stimulation(0.39±0.59)times was lower than that of the local anesthesia group,and the hospitalization time(1.53±0.61)d was longer than that of the local anesthesia group,the differences were statistically significant(t=4.846,3.120,2.593,P<0.05).The VAS scores of the two groups at 3 days and 3 months after operation and the ODI index at 3 months after operation were lower than those before operation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in VAS score and ODI index between the two groups at the same time point(P>0.05).Conclusion The efficacy of percutaneous spinal endoscopic lumbar discectomy for nucleus pulposus removal under general

关 键 词：腰椎间盘突出症 神经电生理 经皮脊柱内镜 髓核摘除术 麻醉 

分 类 号：R4[医药卫生—临床医学]