经皮椎间孔镜髓核摘除术治疗单节段钙化型腰椎间盘突出症的疗效观察
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摘要
目的观察比较经皮椎间孔镜髓核摘除术及椎板开窗髓核摘除术治疗单节段钙化型腰椎间盘突出症的疗效。方法选择2015年3月—2018年3月在广西钦州市第二人民医院骨三科接受椎间孔镜髓核摘除术治疗的单节段钙化型腰椎间盘突出症患者50例作为观察组,同期在医院接受椎板开窗髓核摘除术治疗的单节段钙化型腰椎间盘突出症患者45例作为对照组。比较2组患者围手术情况、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、血清肌红蛋白含量、腓总神经及胫神经的神经传导速度(NCV)的差异。结果观察组患者的手术时间、神经根过敏及表皮感染发生率与对照组比较差异无统计学意义(P>0.05),观察组患者术中出血量、术后引流量、术后VAS评分、ODI评分、血清肌红蛋白含量均明显低于对照组(t/P=19. 128/0.000,16. 397/0.000,20. 198/0. 000,8. 446/0.000,5.584/0.000),腓总神经及胫神经的NCV均明显高于对照组(t/P=2.223/0.029,2.588/0.011)。结论经皮椎间孔镜髓核摘除术治疗单节段钙化型腰椎间盘突出症的疗效优于椎板开窗髓核摘除术。
Objective To observe the curative effect of percutaneous transforaminal endoscopic nucleus pulposus removal and laminotomy for single-segment calcified lumbar disc herniation. Methods From March 2015 to March 2018, 50 patients with single-segment calcified lumbar intervertebral disc herniation who underwent endoscopic discectomy in Orthopedics Department of Qinzhou Second People's Hospital of Guangxi were selected as the observation group, while 45 patients with single-segment calcified lumbar disc herniation who underwent fenestration discectomy in hospital were selected as the control group. Perioperative conditions, visual analogue scale( VAS), Oswestry dysfunction index(ODI), serum myoglobin content,nerve conduction velocity(NCV) of common peroneal nerve and tibial nerve were compared between the two groups. Results There was no significant difference in the operation time, nerve root allergy and epidermal infection between the observation group and the control group( P >0.05). The intraoperative blood loss, postoperative drainage, postoperative VAS score and ODI score were observed in the observation group. The serum myoglobin content was significantly lower than that of the control group(t/P = 19.128/0.000, t/P = 16.397/0.000, t/P = 20.198/0.000, t/P = 8.446/0.000,t/P =5.584/0.000), NCV of common peroneal nerve and phrenic nerve were significantly higher than the control group(t/P =2.223/0.029, t/P =2.588/0.011). Conclusion Percutaneous transforaminal endoscopic nucleus pulpectomy for single-segment calcified lumbar disc herniation is superior to fenestration.
Objective To observe the curative effect of percutaneous transforaminal endoscopic nucleus pulposus removal and laminotomy for single-segment calcified lumbar disc herniation. Methods From March 2015 to March 2018, 50 patients with single-segment calcified lumbar intervertebral disc herniation who underwent endoscopic discectomy in Orthopedics Department of Qinzhou Second People's Hospital of Guangxi were selected as the observation group, while 45 patients with single-segment calcified lumbar disc herniation who underwent fenestration discectomy in hospital were selected as the control group. Perioperative conditions, visual analogue scale( VAS), Oswestry dysfunction index(ODI), serum myoglobin content,nerve conduction velocity(NCV) of common peroneal nerve and tibial nerve were compared between the two groups. Results There was no significant difference in the operation time, nerve root allergy and epidermal infection between the observation group and the control group( P >0.05). The intraoperative blood loss, postoperative drainage, postoperative VAS score and ODI score were observed in the observation group. The serum myoglobin content was significantly lower than that of the control group(t/P = 19.128/0.000, t/P = 16.397/0.000, t/P = 20.198/0.000, t/P = 8.446/0.000,t/P =5.584/0.000), NCV of common peroneal nerve and phrenic nerve were significantly higher than the control group(t/P =2.223/0.029, t/P =2.588/0.011). Conclusion Percutaneous transforaminal endoscopic nucleus pulpectomy for single-segment calcified lumbar disc herniation is superior to fenestration.
引文
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[12] Linzer P, Filip M, Samal F,et al. Comparison of Biochemical Markers of Muscle Damage and Inflammatory Response Between the Open Discectomy, Microsurgical Discectomy, and Microsurgical Discectomy Using Tubular Retractor[J]. J Neurol Surg A Cent Eur Neurosurg, 2015, 76(5):384-391. DOI:10. 1055/s-0034-1393929.
[13]郭团茂,行艳丽,曹伟宁,等.三种手术方法治疗腰椎间盘突出症中期疗效比较[J].疑难病杂志,2019,18(2):175-178. DOI:10.3969/j. issn. 1671-6450. 2019.02.017.
[14]王国庆,胡涌亮,蒋曙,等.前路椎间盘减压融合治疗对多节段颈椎病患者JOA评分和颈椎活动度的影响[J].中国医药,2017,12(1):114-117. DOI:10. 3760/cma. j. issn. 1673-4777. 2017. 01.027.
[15]陈海霞,赵瑞娟.表面肌电图在腰骶神经根病诊断中的价值[J].神经损伤与功能重建,2018,13(4):215-216. DOI:10.16780/j. cnki. sjssgncj. 2018.04.019.
[16]叶红,崔志明,徐冠华,等.自由肌电图监测在脊柱内镜下经椎板间入路腰椎间盘切除术中的初步应用[J].中国脊柱脊髓杂志,2018, 28(3):213-218. DOI:10. 3969/j. issn. 1004-406X.2018.03.04.
[2]俞勇,吴世舫.三种术式联合治疗腰椎间盘突出症合并腰椎管狭窄的疗效分析[J].临床外科杂志,2016,24(6):453-454.DOI:10. 3969/j. issn. 1005-6483.2015.06.020.
[3]李东,常志泳,蔡平,等.经皮椎间孔镜与椎间盘镜髓核摘除术治疗腰椎间盘突出症的比较[J].中国骨与关节损伤杂志,2018, 33(9):921-924. DOI:10. 7531/j. issn. 1672-9935.2018.09.007.
[4]邵楠,张胜国,邓茂松,等.经皮椎间孔镜TESSYS技术对腰椎间盘突出症患者应激反应及临床疗效的影响[J].颈腰痛杂志,2018, 39(5):672-673. DOI:10. 3969/j. issn. 1005-7234. 2018.05.002.
[5]马树伟,吴继功.三种开放手术方式治疗腰4/5椎间盘突出症的疗效对比[J].河北医学,2018,24(7):1155-1161.DOI:10.3969/j. issn. 1006-6233.2018.07.025.
[6]赵兵,崔易坤,宋晋刚,等.腰椎间盘突出症再手术原因分析与手术方式选择[J].成都医学院学报,2016, 11(5):592-596,601. DOI:10.3969/j. issn. 1674-2257.2016.05.018.
[7]梁仁根,樊天佑,吴文虎,等.经皮椎间孔镜技术治疗腰椎间盘突出并腰椎管狭窄症的临床研究[J].颈腰痛杂志,2018, 39(2):245-246. DOI:10.3969/j. issn. 1005-7234.2018.02.002.
[8]丁海蛟,王天胜,付雷,等.经皮椎间孔镜下椎间盘切除术治疗腰椎间盘突出症效果观察[J].临床军医杂志,2018, 46(9):1081-1082. DOI:10.16680/j. 1671-3826.2018.09.34.
[9]Liu W, Li Q, Li Z, et al. Clinical efficacy of percutaneous transforaminal endoscopic discectomy in treating adolescent lumbar disc herniation[J]. Medicine(Baltimore), 2019, 98(9):e14682. DOI:10. 1097/MD. 0000000000014682.
[10]李俊.椎间盘镜手术及椎板开窗手术后腰椎间盘突出患者神经传导及损伤程度的比较[J].海南医学院学报,2017, 23(18):2517-2520. DOI:10. 13210/j. cnki.jhmu. 20170829.001.
[11]汪宇,庞广兴,张海滨,等.显微内窥镜椎间盘髓核摘除术与传统椎板开窗髓核摘除术对患者创伤反应的临床观察[J].中国实用医药,2016,11(16):43-44. DOI:10. 14163/j. cnki. 11-5547/r. 2016. 16.024.
[12] Linzer P, Filip M, Samal F,et al. Comparison of Biochemical Markers of Muscle Damage and Inflammatory Response Between the Open Discectomy, Microsurgical Discectomy, and Microsurgical Discectomy Using Tubular Retractor[J]. J Neurol Surg A Cent Eur Neurosurg, 2015, 76(5):384-391. DOI:10. 1055/s-0034-1393929.
[13]郭团茂,行艳丽,曹伟宁,等.三种手术方法治疗腰椎间盘突出症中期疗效比较[J].疑难病杂志,2019,18(2):175-178. DOI:10.3969/j. issn. 1671-6450. 2019.02.017.
[14]王国庆,胡涌亮,蒋曙,等.前路椎间盘减压融合治疗对多节段颈椎病患者JOA评分和颈椎活动度的影响[J].中国医药,2017,12(1):114-117. DOI:10. 3760/cma. j. issn. 1673-4777. 2017. 01.027.
[15]陈海霞,赵瑞娟.表面肌电图在腰骶神经根病诊断中的价值[J].神经损伤与功能重建,2018,13(4):215-216. DOI:10.16780/j. cnki. sjssgncj. 2018.04.019.
[16]叶红,崔志明,徐冠华,等.自由肌电图监测在脊柱内镜下经椎板间入路腰椎间盘切除术中的初步应用[J].中国脊柱脊髓杂志,2018, 28(3):213-218. DOI:10. 3969/j. issn. 1004-406X.2018.03.04.