两种手术方式治疗钙化型腰椎间盘突出的疗效对比  

Comparison of the efficacy of two surgical methods in the treatment of calcified lumbar disc herniation

作　　者：涂兵 宋磊 练沛荣 陈钧麟 马向阳 易红蕾 TU Bing;SONG Lei;LIAN Peirong;CHEN Junlin;YI Honglei(Department of Orthopedics,General Hospital of Southern Theater Command of People's Liberation Army,Guangzhou,Guangdong 510010,China;不详)

机构地区：[1]中国人民解放军南部战区总医院脊柱外科,广州510010 [2]陆军军医大学第一附属医院骨科,重庆400038

出　　处：《中国骨科临床与基础研究杂志》2024年第1期16-20,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：广东省医学科学技术研究基金(A2023479);广州市科技计划项目(201803010046)。

摘　　要：目的对比经皮内镜下髓核摘除术和腰椎后路单纯髓核摘除术对治疗钙化型腰椎间盘突出的临床疗效。方法回顾性分析2019年8月至2022年8月南部战区总医院收治的55例钙化型腰椎间盘突出患者的临床资料,按手术方式的不同分为微创组和传统组,其中微创组采用经皮内镜下髓核摘除术(n=25),传统组采用腰椎后路单纯髓核摘除术(n=30)。对比两组手术时间、切口长度、出血量、住院时间、疼痛视觉模拟量表(VAS)评分、腰椎功能障碍指数(ODI)和术后并发症。结果微创组手术时间长于传统组,但切口长度、术中出血量、住院时间少于传统组;两组术后VAS评分和ODI均较术前改善,且微创组术后随访3、12个月VAS评分及术后3个月ODI均优于传统组(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论相对于腰椎后路单纯髓核摘除术,经皮内镜下髓核摘除术操作复杂,手术时间长,但创伤小、恢复快、疗效满意,是治疗钙化型腰椎间盘突出的优选术式。Objective To compare the clinical effects between percutaneous endoscopic extraction of nucleus pulposus and posterior lumbar simple extraction of nucleus pulposus in the treatment of calcified lumbar disc herniation.Methods Clinical data of 55 patients with calcified lumbar disc herniation admitted to General Hospital of Southern Theater Command from August 2019 to August 2022 were retrospectively analyzed.According to different surgical method,patients were divided into two groups,traditional group and minimally invasive surgery(MIS)group.Patients in traditional group were performed posterior lumbar simple extraction of nucleus pulpoideus(n=30),while patients in MIS group underwent percutaneous endoscopic extraction of nucleus pulpoideus,respectively(n=25).Operative time,incision length,intraoperative blood loss,length of hospital stay,visual analogue scale(VAS)score and Oswestry disability index(ODI)as well as postoperative complications were compared between two groups.Results Operation time of MIS group was longer than that of traditional group,but the incision length,intraoperative blood loss and hospital stay were lower than those of traditional group(P<0.05).Postoperative VAS scores and ODI were better than preoperative ones in two groups,and VAS score at 3,12 months and ODI at 3 months after the surgery in MIS group were lower than those of traditional group(P<0.05).As for incidence of postoperative complications,no statistical difference was found between the two groups(P>0.05).Conclusion Compared with posterior lumbar simple extraction of nucleus pulposus,percutaneous endoscopic extraction of nucleus pulposus is complicated and lasts a long time,while it is still a good choice for treatment of patients with calcified lumbar disc herniation with little trauma,fast recovery and satisfactory clinical effect.

关 键 词：腰椎 椎间盘移位 椎间盘切除术 内窥镜检查 钙化 

分 类 号：R681.533.1[医药卫生—骨科学] R687.3[医药卫生—外科学]