经皮椎间孔镜下髓核摘除术治疗中青年腰椎间盘突出症的临床研究
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摘要
目的观察椎间孔镜下髓核摘除术治疗中青年腰椎间盘突出症(LDH)患者的临床短期效果。方法选取2016年10月至2018年3月该科收治的40例LDH中青年患者,按照手术方式分为对照组和观察组,各20例。对照组行后路小切口经椎板间髓核摘除术,观察组行椎间孔镜下髓核摘除术。对比2组临床疗效,采用视觉模拟评分法(VAS)评估2组手术前后疼痛程度,采用日本骨科协会(JOA)下腰痛评分量表评估2组手术前后功能障碍程度。结果观察组治疗总有效率[90.0%(18/20)]高于对照组[85.0%(17/20)],差异有统计学意义(P<0.05);术后1d、1个月和3个月观察组VAS及JOA评分均低于对照组,差异有统计学意义(P<0.05)。结论椎间孔镜下髓核摘除术治疗中青年LDH患者效果显著,有效避免因脊柱结构破坏、椎间隙高度降低等传统开放手术后造成的长期腰背疼痛。
Objective To observe the short-term effect of endoscopic nucleus pulposus removal in the treatment of middleaged and young patients with lumbar disc herniation(LDH).Methods Forty young and middle-aged patients with LDH admitted to the hospital from October 2016 to March 2018 were randomly divided into two groups,each group with 20 cases.The control group underwent posterior small incision translaminar nucleus pulposus removal,while the observation group underwent transforaminal endoscopic nucleus pulposus removal.The clinical effects of the two groups was compared.The degree of pain before and after operation was evaluated by visual analogue scale(VAS),and the degree of functional impairment before and after operation was assessed by Japanese Orthopaedic Association(JOA)Lower Back Pain Scale.Results The total effective rate of the observation group[90.0%(18/20)]was higher than that of the control group[85.0%(17/20)],the difference was statistically significant(P<0.05);the VAS and JOA scores of the observation group were lower than those of the control group 1 d,1 month and 3 months after operation,the differences were statistically significant(P<0.05).Conclusion Intervertebral foramen endoscopic nucleus pulpectomy has a significant effect in the treatment of young and middle-aged LDH patients.It can effectively avoid the long-term back pain caused by traditional open surgery for destruction of spinal structure and reduction of intervertebral space height.
Objective To observe the short-term effect of endoscopic nucleus pulposus removal in the treatment of middleaged and young patients with lumbar disc herniation(LDH).Methods Forty young and middle-aged patients with LDH admitted to the hospital from October 2016 to March 2018 were randomly divided into two groups,each group with 20 cases.The control group underwent posterior small incision translaminar nucleus pulposus removal,while the observation group underwent transforaminal endoscopic nucleus pulposus removal.The clinical effects of the two groups was compared.The degree of pain before and after operation was evaluated by visual analogue scale(VAS),and the degree of functional impairment before and after operation was assessed by Japanese Orthopaedic Association(JOA)Lower Back Pain Scale.Results The total effective rate of the observation group[90.0%(18/20)]was higher than that of the control group[85.0%(17/20)],the difference was statistically significant(P<0.05);the VAS and JOA scores of the observation group were lower than those of the control group 1 d,1 month and 3 months after operation,the differences were statistically significant(P<0.05).Conclusion Intervertebral foramen endoscopic nucleus pulpectomy has a significant effect in the treatment of young and middle-aged LDH patients.It can effectively avoid the long-term back pain caused by traditional open surgery for destruction of spinal structure and reduction of intervertebral space height.
引文
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[9]朱小建,姚羽.侧后路椎间孔镜与后路开窗手术治疗腰椎间盘突出症的对比分析[J].交通医学,2018,32(1):39-42.
[10]赵继荣,朱宝.经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症5年国内文献分析[J].中国中医骨伤科杂志,2015,10(23):34-37.
[11]李兴艳,张津铭,叶亚平,等.经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的疗效对比[J].中国骨与关节损伤杂志,2015,30(5):467-469.
[2]李铭.腰椎间盘突出症防治之浅见[J].中外医学研究,2011,14(3):36.
[3]苏克红,赵勇.综合治疗腰椎盘突出症的临床效果分析[J].内蒙古中医药,2014,33(1):81-82.
[4] YEUNG AT,TSOU PM.Posterolateral endoscopic excision for lumbar disc herniation:surgical technique,outcome,and complications in 307consecutive cases[J].Spine,2002,27(7):722-731.
[5] HOOGLAND T,SCHUBERT M,MIKLITZ B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain:aprospective randomized study in 280consecutive cases[J].Spine,2006,31(24):E890-897.
[6] RUETTEN S,KOMP M,GODOLIAS G.An extreme lateral access for the surgery of lumbar disc heniations inside the spinal canal using the full endoscopic uniportal transforaminal approach technique prospective result of 463patients[J].Spine,2005,30(22):2570-2578.
[7]周跃,李长青.椎间孔镜YESS与TESSYS技术治疗腰椎间盘突出症[J].中华骨科杂志,2010,30(3):2253-2352.
[8]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.
[9]朱小建,姚羽.侧后路椎间孔镜与后路开窗手术治疗腰椎间盘突出症的对比分析[J].交通医学,2018,32(1):39-42.
[10]赵继荣,朱宝.经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症5年国内文献分析[J].中国中医骨伤科杂志,2015,10(23):34-37.
[11]李兴艳,张津铭,叶亚平,等.经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的疗效对比[J].中国骨与关节损伤杂志,2015,30(5):467-469.