经皮内镜下腰椎间盘切除术治疗不同Pfirrmann分级单节段腰椎间盘突出症的疗效评价  

Evaluation of the efficacy of percutaneous endoscopic lumbar discectomy in the treatment of different Pfirrmann graded single-segment lumbar disc herniation

作　　者：桑廷瑞 夏斌[1] 王婷 石瑞芳[3] 陈伟国 雒永生[4] 朱焕平[4] 李晨旭[5] SANG Tingrui;XIA Bin;WANG Ting;SHI Ruifang;CHEN Weiguo;LUO Yongsheng;ZHU Huanping;LI Chenxu(The Third Ward of Spine Center,Baoji Traditional Chinese Medicine Hospital,Baoji 721000;Baoji People′s Hospital,Baoji 721000;Orthopedic Outpatient Clinic,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050;Department of Minimally Invasive Spinal Orthopedics,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050;Third Department of Spinal Orthopedics,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050)

机构地区：[1]宝鸡市中医医院脊柱中心3病区,宝鸡721000 [2]宝鸡市人民医院,宝鸡721000 [3]甘肃省中医院骨科门诊,兰州730050 [4]甘肃省中医院脊柱微创骨科,兰州730050 [5]甘肃省中医院脊柱骨三科,兰州730050

出　　处：《颈腰痛杂志》2025年第2期267-273,共7页The Journal of Cervicodynia and Lumbodynia

基　　金：甘肃省自然科学基金项目(21JR1RA058);甘肃省联合科研基金项目(24JRRA898)。

摘　　要：目的探讨经皮内镜腰椎间盘切除术(PELD)治疗不同Pfirrmann分级单节段椎间盘突出症的安全性及临床疗效。方法回顾性分析2021年5月至2022年4月甘肃省中医院脊柱微创骨科行PELD治疗的58例单节段椎间盘突出症患者临床资料,其中Ⅱ级16例(男性9例,女性7例),Ⅲ级20例(男性10例,女性10例),Ⅳ级22例(男性13例,女性9例)。记录患者的年龄、病程、手术时间、住院天数等一般资料,并比较术前、术后3 d、1个月、3个月的腰腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),评估术后疼痛改善及功能恢复情况,同时采用改良MacNab标准评价术后3个月的临床疗效。结果所有患者均完成随访,三组患者一般资料差异无统计学意义,且均未出现硬膜撕裂、硬膜外血肿或神经血管损伤等并发症。术后随访结果显示,术后3 d、1个月和3个月,不同Pfirrmann分级患者的VAS评分和ODI评分均较术前明显降低(P<0.001);组内术后各时间节点间比较,PfirrmannⅢ、Ⅳ级患者术后1个月与术后3个月VAS评分及ODI评分差异无统计学意义(P>0.05);组间比较,PfirrmannⅡ级与Ⅲ级患者各时间节点VAS评分及ODI评分差异无统计学意义(P>0.05);PfirrmannⅡ级、Ⅲ级与Ⅳ级术后1个月、3个月VAS评分比较,差异有统计学意义(P<0.05);PfirrmannⅡ级、Ⅲ级与Ⅳ级术后各时间节点的ODI评分比较,差异有统计学意义(P<0.05)。根据改良MacNab标准,术后3个月随访显示,Ⅱ级优良率93.75%,Ⅲ级85.00%,Ⅳ级72.72%。结论PELD治疗不同Pfirrmann分级单节段椎间盘突出症安全性高,近期疗效可靠,尤其对Ⅱ、Ⅲ级患者疗效更佳。Objective To investigate the safety and clinical efficacy of percutaneous endoscopic lumbar discectomy(PELD)in the treatment of single-level disc herniation with different Pfirrmann grades.Methods Clinical data of 58 patients with single-segment disc herniation treated with PELD in the spine minimally invasive orthopedics department of Gansu Hospital of Traditional Chinese Medicine from May 2021 to April 2022 were retrospectively analyzed,including 16 cases in GradeⅡ(9 males and 7 females),andⅢ20 cases(10 males and 10 females),22 cases(13 males and 9 females).Record the patient′s age,course of illness,surgery time,hospitalization days and other general information,and compare the visual analog score(VAS)of lumbar pain and Oswestry dysfunction index(ODI)before and after surgery(3 days,1 month and 3 months after surgery),evaluate postoperative pain improvement and functional recovery,and use modified MacNab standards to evaluate the clinical efficacy of 3 months after surgery.Results All patients completed follow-up,and there was no significant difference in the general data of the three groups of patients,and no complications such as dural tears,epidural hematoma or neurovascular damage were found.The results of postoperative follow-up showed that the VAS scores and ODI scores of patients with different Pfirrmann grades were significantly lower than those of preoperative 3 days,1 month and 3 months after surgery(P<0.001);Compared with each time node after surgery within the group,there was no significant difference in VAS scores and ODI scores of Pfirrmann gradeⅢandⅣpatients 1 month after surgery and 3 months after surgery(P>0.05);During the intergroup comparison,there was no significant difference in VAS scores and ODI scores of Pfirrmann gradeⅡand gradeⅢpatients(P>0.05);VAS scores of Pfirrmann gradeⅡ,gradeⅢand gradeⅣwere compared with 1 month and 3 months after surgery.The differences were statistically significant(P<0.05);the ODI scores of Pfirrmann gradeⅡ,gradeⅢand gradeⅣpostoperative

关 键 词：Pfirrmann分级 腰椎退行性病变 腰椎间盘突出症 经皮内镜腰椎间盘切除术 视觉模拟评分 Oswestry腰椎功能障碍指数 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]