经皮椎间孔镜下髓核切除术与小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症患者对比研究
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摘要
目的:探讨经皮椎间孔镜下髓核切除术与小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症的效果及安全性。方法:选取我院2016年12月至2018年7月腰椎间盘突出症患者70例,根据手术方式分为开窗组(n=35)与内镜组(n=35)。开窗组采取小切口椎板间开窗髓核摘除术,内镜组采取经皮椎间孔镜下髓核切除术。统计两组围术期情况(手术时长、切口长度、术中失血量、卧床时间、住院时间)、术前及术后第1天、术后1个月、术后2个月疼痛程度分值(VAS)、术前及术后Oswestry功能障碍指数评分(ODI)及日本骨科协会治疗评分(JOA)、治疗优良率、并发症发生率。结果:内镜组切口长度短于开窗组,术中失血量少于开窗组,手术时长、卧床时间及住院时间短于开窗组(P<0.05);术前两组VAS分值间无显著差异(P>0.05),术后第1天、术后1个月、术后2个月两组VAS分值较术前降低(P<0.05),但组间比较无显著差异(P>0.05);术前两组ODI及JOA分值间无显著差异(P>0.05),术后两组ODI分值较术前降低,JOA分值较术前增高(P<0.05),但组间比较无显著差异(P>0.05);内镜组治疗优良率(94.29%)与开窗组(88.57%)间无显著差异(P>0.05);内镜组并发症发生率(8.57%)低于开窗组(28.57%)(P<0.05)。结论:采取经皮椎间孔镜下髓核切除术及小切口椎板间开窗髓核摘除术对腰椎间盘突出症患者予以治疗,均可有效减轻疼痛感,改善患者腰椎功能,但经皮椎间孔镜下髓核切除术在减少手术创伤方面更具显著优势,且可减少术后并发症,具有安全性。
Objective: To evaluate the efficacy and safety of percutaneous transforaminal nucleotomy and small incision interlaminar nucleus pulposus in the treatment of lumbar disc herniation. Methods: 70 patients with lumbar disc herniation from December 2016 to July 2018 were enrolled in our hospital. According to the surgical procedure,they were divided into the open window group (n = 35) and the endoscopy group (n =35). The fenestration group was treated with small incision interlaminar nucleus pulposus removal,and the endoscopic group was treated with percutaneous transforaminal nucleus pulpectomy. Perioperative conditions (surgery duration,length of incision,intraoperative blood loss,bed rest time,hospital stay),preoperative and postoperative 1 d,postoperative 1 month,postoperative 2 months pain scores,preoperative and postoperative oswestry dysfunction index score (ODI) and Japanese orthopaedic association treatment score (JOA),treatment rate,and complication rate were counted. (VAS). Results: The length of incision in the endoscopy group was shorter than that in the fenestration group. The intraoperative blood loss was less than that in the fenestration group. The length of operation,bed time and hospital stay were shorter than those in the fenestration group (P <0.05). There was no significant difference VAS score between the two groups before operation. (P >0.05),the VAS scores of the two groups were lower than those before surgery (P <0.05),but there was no significant difference between the two groups (P >0.05); There was no significant difference between the two groups (P > 0. 05). The ODI scores of the two groups were lower than those before operation,and the JOA scores were higher than those before surgery (P <0.05). There was no significant difference (P >0.05). There was no significant difference between the excellent rate of endoscopic treatment (94.29%) and the fenestration group (88.57%) (P >0.05). The incidence of endoscopic complication (8.57%) was lower than that in the window group (28.57%) (P <0.05). Conclusion: Percutaneous transforaminal resection of nucleus pulposus and small incision fenestration of nucleus pulposus can effectively relieve pain and improve lumbar function in patients with lumbar disc herniation. However,percutaneous transforaminal resection of nucleus pulposus has more significant advantages in reducing surgical trauma,and can reduce postoperative complications and has safety.
Objective: To evaluate the efficacy and safety of percutaneous transforaminal nucleotomy and small incision interlaminar nucleus pulposus in the treatment of lumbar disc herniation. Methods: 70 patients with lumbar disc herniation from December 2016 to July 2018 were enrolled in our hospital. According to the surgical procedure,they were divided into the open window group (n = 35) and the endoscopy group (n =35). The fenestration group was treated with small incision interlaminar nucleus pulposus removal,and the endoscopic group was treated with percutaneous transforaminal nucleus pulpectomy. Perioperative conditions (surgery duration,length of incision,intraoperative blood loss,bed rest time,hospital stay),preoperative and postoperative 1 d,postoperative 1 month,postoperative 2 months pain scores,preoperative and postoperative oswestry dysfunction index score (ODI) and Japanese orthopaedic association treatment score (JOA),treatment rate,and complication rate were counted. (VAS). Results: The length of incision in the endoscopy group was shorter than that in the fenestration group. The intraoperative blood loss was less than that in the fenestration group. The length of operation,bed time and hospital stay were shorter than those in the fenestration group (P <0.05). There was no significant difference VAS score between the two groups before operation. (P >0.05),the VAS scores of the two groups were lower than those before surgery (P <0.05),but there was no significant difference between the two groups (P >0.05); There was no significant difference between the two groups (P > 0. 05). The ODI scores of the two groups were lower than those before operation,and the JOA scores were higher than those before surgery (P <0.05). There was no significant difference (P >0.05). There was no significant difference between the excellent rate of endoscopic treatment (94.29%) and the fenestration group (88.57%) (P >0.05). The incidence of endoscopic complication (8.57%) was lower than that in the window group (28.57%) (P <0.05). Conclusion: Percutaneous transforaminal resection of nucleus pulposus and small incision fenestration of nucleus pulposus can effectively relieve pain and improve lumbar function in patients with lumbar disc herniation. However,percutaneous transforaminal resection of nucleus pulposus has more significant advantages in reducing surgical trauma,and can reduce postoperative complications and has safety.
引文
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[6]方卫军,李章华,潘峰,等.经皮椎间孔镜与椎板开窗治疗腰椎间盘突出症的疗效分析[J].现代生物医学进展,2016,16(34):6660~6664.
[7]郭学文.经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较[J].中国医疗器械信息,2016,22(10):48~49.
[8]Gotecha S,Ranade D,Patil S V,et al.The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations[J].Craniovertebr Junction Spine,2016,7(4):217~223.
[2]Sinkemani A,Hong X,Gao Z X,et al.Outcomes of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation:a comparative retrospective study[J].Asian Spine,2015,9(6):833~840.
[3]黄勇全,温俭,陈文明,等.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症疗效分析[J].上海医药,2017,38(6):21~24.
[4]Passacantilli E,Lenzi J,Caporlingua F,et al.Endoscopic interlaminar approach for intracanal L5‐S1 disc herniation:Classification of disc prolapse in relation to learning curve and surgical outcome[J].Asian Endosc Surg,2015,8(4):445~453.
[5]Liu C,Zhou Y.Percutaneous endoscopic lumbar discectomy and minimally invasive transforaminal lumbar interbody fusion for recurrent lumbar disc herniation[J].World Neurosurg,2016,98(1):14~20.
[6]方卫军,李章华,潘峰,等.经皮椎间孔镜与椎板开窗治疗腰椎间盘突出症的疗效分析[J].现代生物医学进展,2016,16(34):6660~6664.
[7]郭学文.经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较[J].中国医疗器械信息,2016,22(10):48~49.
[8]Gotecha S,Ranade D,Patil S V,et al.The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations[J].Craniovertebr Junction Spine,2016,7(4):217~223.