改良Pfirrmann分级评估脊柱内镜治疗腰椎间盘突出症的疗效分析  

Value of modified pfirrmann grading in evaluating the efficacy of percutaneous endoscopic lumbar discetomy in the treatment of patients with lumbar disc herniation

作　　者：姜晓涵 李石耀 孙涛[1] JIANG Xiaohan;LI Shiyao;SUN Tao(Department of Pain Management,Shandong Provincial Hospital,Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院疼痛科,济南250021

出　　处：《中国疼痛医学杂志》2023年第11期831-839,共9页Chinese Journal of Pain Medicine

基　　金：国家自然科学基金(81972145)。

摘　　要：目的:评价改良Pfirrmann分级在经皮脊柱内镜下腰椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)治疗腰椎间盘突出症(lumbar disc herniation,LDH)术后疗效中的临床价值。方法:收集山东大学附属省立医院疼痛科2020年11月至2022年8月接受PELD治疗的252例LDH病人信息,术前按责任间盘改良Pfirrmann分级分为高分级组(A组)114例和低分级组(B组)138例。经倾向性评分匹配法(propensity score matching,PSM)平衡两组病人的基线资料差异后,对两组病人术前及术后7天、1、3、6个月的数字分级评分法(numerical rating scale,NRS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)及改良Mac Nab优良率进行对比分析。结果:两组术后各时间点NRS评分、ODI评分及PSQI评分均较术前明显改善。术后7天、1、3、6个月B组NRS评分、ODI评分均低于A组;术后1、3、6个月B组PSQI评分均低于A组;术后7天、1、3、6个月B组的改良Mac Nab优良率均高于A组。结论:B组疗效明显优于A组,与PELD治疗LDH的疗效具有相关性。这对术前病人的合理选择、术后疗效的预测具有重要的临床价值。Objective:To assess the predictive value of the modified Pfirrmann grading system in the treatment of lumbar disc herniation(LDH)by percutaneous endoscopic lumbar discectomy(PELD).Methods:Information of 252 LDH patients treated in the Pain Department of Shandong Provincial Hospital from November 2020 to August 2022 was collected,and divided into the high grade group(group A,n=114)and the low grade group(group B,n=138)according to the modified Pfirrmann grading system of herniation discs.After differences of baseline data being balanced by propensity score matching(PSM),the scores of numerical rating scale(NRS),Oswestry disability index(ODI),Pittsburgh sleep quality index(PSQI)and modified MacNab excellent and good rate were compared and analyzed before surgery,7 d after surgery,and 1,3,6 months after surgery.Results:NRS scores,ODI scores and PSQI scores were significantly improved in both groups at difffferent time points after surgery.Compared with group A,the NRS scores and ODI scores were signifificantly decreased at 7 d after surgery and 1,3,6 months after surgery in group B.Compared with group A,the PSQI scores were significantly decreased at 1,3,6 months after surgery in group B.Modified MacNab excellent and good rates in the group B were significantly higher than those in the group A at 7 d after surgery and 1,3,6 months after surgery.Conclusion:The efficacy of the group B was significantly better than that of the group A.The modified Pfirrmann grading system is correlated with the efficacy of PELD in the treatment of LDH,which has important clinical value for the rational selection of patients before surgery and the prediction of postoperative efficacy.

关 键 词：改良Pfirrmann分级 倾向性评分匹配 经皮脊柱内镜下腰椎间盘摘除术 腰椎间盘突出症 临床价值 

分 类 号：R687.3[医药卫生—骨科学]