经皮椎间孔镜下髓核摘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的对比研究
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摘要
目的:对比经皮椎间孔镜下髓核摘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(LDH)的临床价值。方法:选取我院60例LDH患者(2016年11月至2018年2月期间收治),将行经皮椎间孔镜下髓核摘除术者分为椎间孔镜组,将行小切口椎板间开窗髓核摘除术分为小切口组,每组30例。对比两组手术及术后恢复情况、术后并发症发生率,随访至术后6个月,对比两组手术疗效、功能改善情况[Oswestry功能障碍指数(ODI)、日本矫形外科评分(JOA)]及生活质量(SF-36)评分。结果:手术及术后恢复情况:椎间孔镜组切口长度、手术用时、术后卧床时间及住院时间短于小切口组,手术出血量及椎间盘切除量少于小切口组(P<0.05);术后并发症:椎间孔镜组术后并发症发生率6.67%(2/30)低于小切口组26.67%(8/30)(P<0.05);手术疗效:椎间孔镜组手术疗效优良率86.67%(26/30)与小切口组83.33%(25/30)比较无显著差异(P>0.05);功能改善情况:术后6个月,椎间孔镜组与小切口组ODI指数及JOA评分均较手术前改善(P<0.05),但两组间比较无显著差异(P>0.05);生活质量:术后6个月,椎间孔镜组与小切口组SF-36评分均较手术前提高,且椎间孔镜组高于小切口组(P<0.05)。结论:经皮椎间孔镜下髓核摘除术与小切口椎板间开窗髓核摘除术治疗LDH,均可取得显著手术效果,改善患者功能障碍、提高腰椎功能,但前者较后者更具微创优势,手术创伤小、术后恢复快,更利于改善患者术后生活质量。
Objective: To compare the clinical value of percutaneous transforaminal nucleus pulposus and small incision interlaminar nucleus pulposus removal for lumbar disc herniation(LDH). Methods: 60 patients with LDH in our hospital from November 2016 to February 2018 were enrolled. Percutaneous transforaminal nucleus pulposus removal was divided into intervertebral foramen. The nucleus pulposus extraction was divided into small incision groups, 30 cases in each group. The operation and postoperative complications were compared between the two groups. The follow-up to 6 months after surgery, the efficacy and functional improvement of the two groups were compared [Oswestry dysfunction index(ODI), Japanese orthopedic surgery score(JOA)] and quality of life(SF-36) score were counted. Results: Surgery and postoperative recovery: The length of the incision in the intervertebral foramen group, the time of surgery, the time of bed rest and the length of hospital stay were shorter than that of the small incision group. The amount of surgical bleeding and discectomy was less than that of the small incision group(P<0.05). Postoperative complications: The incidence of postoperative complications in the vertebral foramen group was 6.67%(2/30), which was lower than that in the small incision group(26.67%(8/30)(P<0.05); Surgical efficacy: The excellent and good rate of surgery in the intervertebral foramen group was 86.67%(26/30), and there was no significant difference between the small incision group and 83.33%(25/30)(P>0.05). Functional improvement: postoperative 6 The ODI index and JOA score of the intervertebral foramen and small incision group were improved compared with those before operation(P<0.05), but there was no significant difference between the two groups(P>0.05). Quality of life: postoperative At 6 months, the SF-36 scores of the intervertebral foramen group and the small incision group were higher than those before the operation, and the intervertebral foramen group was higher than the small incision group(P<0.05). Conclusion: Percutaneous transforaminal nucleus pulposus and small incision interlaminar nucleus pulposus extraction for LDH can achieve significant surgical results, improve patient dysfunction and improve lumbar function, but the former is more than the latter. The advantages of minimally invasive surgery, small trauma and quick recovery after surgery are more conducive to improving the quality of life of patients after surgery.
Objective: To compare the clinical value of percutaneous transforaminal nucleus pulposus and small incision interlaminar nucleus pulposus removal for lumbar disc herniation(LDH). Methods: 60 patients with LDH in our hospital from November 2016 to February 2018 were enrolled. Percutaneous transforaminal nucleus pulposus removal was divided into intervertebral foramen. The nucleus pulposus extraction was divided into small incision groups, 30 cases in each group. The operation and postoperative complications were compared between the two groups. The follow-up to 6 months after surgery, the efficacy and functional improvement of the two groups were compared [Oswestry dysfunction index(ODI), Japanese orthopedic surgery score(JOA)] and quality of life(SF-36) score were counted. Results: Surgery and postoperative recovery: The length of the incision in the intervertebral foramen group, the time of surgery, the time of bed rest and the length of hospital stay were shorter than that of the small incision group. The amount of surgical bleeding and discectomy was less than that of the small incision group(P<0.05). Postoperative complications: The incidence of postoperative complications in the vertebral foramen group was 6.67%(2/30), which was lower than that in the small incision group(26.67%(8/30)(P<0.05); Surgical efficacy: The excellent and good rate of surgery in the intervertebral foramen group was 86.67%(26/30), and there was no significant difference between the small incision group and 83.33%(25/30)(P>0.05). Functional improvement: postoperative 6 The ODI index and JOA score of the intervertebral foramen and small incision group were improved compared with those before operation(P<0.05), but there was no significant difference between the two groups(P>0.05). Quality of life: postoperative At 6 months, the SF-36 scores of the intervertebral foramen group and the small incision group were higher than those before the operation, and the intervertebral foramen group was higher than the small incision group(P<0.05). Conclusion: Percutaneous transforaminal nucleus pulposus and small incision interlaminar nucleus pulposus extraction for LDH can achieve significant surgical results, improve patient dysfunction and improve lumbar function, but the former is more than the latter. The advantages of minimally invasive surgery, small trauma and quick recovery after surgery are more conducive to improving the quality of life of patients after surgery.
引文
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[10]黄炎,孔雷,孔荣,等.经皮椎间孔镜技术在脊柱微创手术中应用的研究进展[J].中华解剖与临床杂志,2015,20(5):469~472.
[11]范胜利,吴健.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症[J].临床骨科杂志,2017,20(4):401.
[2]唐尚文,王弘,王凌挺,等.小切口椎板开窗髓核摘除术治疗腰椎间盘突出症的近期疗效[J].皖南医学院学报,2018,37(3):227~229.
[3]吕工一,赵合元.经皮内窥镜外科技术治疗腰椎间盘突出症的研究进展[J].中国中西医结合外科杂志,2018,24(4):1430~1434.
[4]中华医学会放射学分会介入学组.腰椎间盘突出症的介入和微创治疗操作规范的专家共识[J].中华放射学杂志,2014,48(1):10~12.
[5]王震,李玉前,王晓东,等.经皮椎间孔镜治疗腰椎间盘突出症的临床效果[J].江苏医药,2015,41(18):2188~2189.
[6]程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235~241.
[7]Kato S,Oshima Y,Oka H,et al.Comparison of the japanese orthopaedic association(JOA)score and modified JOA(m JOA)score for the assessment of cervical myelopathy:a multicenter observational study[J].Plos One,2015,10(4):e0123022.
[8]张殿全,赵宇辉,刘剑,等.电针对腰椎间盘突出症患者健康相关生活质量的影响[J].中医药导报,2017,23(2):69~71.
[9]梁慧,庞利凯.椎间孔镜治疗腰椎间盘突出症术后的MRI观察[J].中国基层医药,2016,23(24):3807~3809.
[10]黄炎,孔雷,孔荣,等.经皮椎间孔镜技术在脊柱微创手术中应用的研究进展[J].中华解剖与临床杂志,2015,20(5):469~472.
[11]范胜利,吴健.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症[J].临床骨科杂志,2017,20(4):401.