经皮椎间孔镜与后路椎间盘镜治疗老年单节段腰椎间盘突出症疗效比较
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摘要
目的比较经皮椎间孔镜与后路椎间盘镜对老年单节段腰椎间盘突出症(lumbar disc herniation,LDH)的治疗效果。方法选择2014年1月至2015年1月本院收治的273例老年单节段LDH患者为研究对象,将其随机分为观察组(137例)和对照组(136例)。观察组患者采用经皮椎间孔镜下腰椎间盘髓核摘除术,对照组患者采用后路椎间盘镜下腰椎间盘切除术,观察并比较两种方法治疗老年单节段LDH的临床效果。结果术前两组患者视觉模拟评分法(visual analogue scale,VAS)评分比较无显著差异(P>0.05),术后两组患者VAS评分均明显低于术前(P<0.05),且术后15天观察组患者VAS评分显著低于对照组(P<0.05)。术后3个月,两组患者VAS评分比较无显著差异(P>0.05)。对照组患者手术时间显著短于观察组(P<0.05),术中透视次数显著少于观察组(P<0.05),术中出血量显著多于观察组(P<0.05),手术切口长度、术后卧床时间及住院天数均显著长于观察组(P<0.05)。两组患者术后Oswestry功能障碍指数(Oswestry dability index,ODI)评分均显著低于术前(P<0.05),但术前及术后组间ODI评分比较均无显著差异(P>0.05)。观察组患者术后并发症发生率显著低于对照组(P<0.05),术后复发率显著高于对照组(P<0.05)。结论经皮椎间孔镜与后路椎间盘镜治疗老年单节段LDH均具有较好的疗效,且经皮椎间孔镜造成的创伤更小,患者恢复更快,术后并发症发生率更低,但复发率较高,需严格掌握手术适应证。
Objective To compare the therapeutic effect of percutaneous transforaminal endoscopic discectomy on elderly patients with senile single segmental lumbar disc herniation(LDH). Method A total of 273 senile single segment LDH patients from January 2014 to January 2015 in our hospital were selected as study subjects, and they were randomly divided into observation group(n =137) and control group(n = 136). Observation group patients were underwent percutaneous transforaminal endoscopic discectomy and control group patients were underwent posterior microendoscopic discectomy. Observed and compared the therapeutic effect of the two methods on elderly single segment LDH patients. Result There was no significant difference in visual analogue scale(VAS) scores between the two groups before operation(P > 0.05). VAS scores in both groups after operation were significantly lower than those before operation(P < 0.05), and 15 days after operation, VAS score of observation group was significantly lower than control group(P < 0.05). 3 months after operation, there was no significant difference in the VAS scores between the two groups(P > 0.05). The operation time of control group was significantly shorter than that of observation group(P < 0.05), the frequency of intraoperative fluoroscopy was significantly less than that of observation group(P < 0.05), and the amount of bleeding during the operation was significantly more than that of observation group(P < 0.05). The length of the incision, the bed time after operation and hospital stay were significantly longer than those in observation group(P < 0.05). The Oswestry dability index(ODI) scores of the two groups were significantly lower than those before operation(P < 0.05), but there was no significant difference between the two groups in ODI scores before and after operation(P > 0.05). The incidence of postoperative complications in observation group was significantly lower than control group(P < 0.05), but the recurrence rate was significantly higher than control group(P < 0.05). Conclusion Percutaneous transforaminal endoscopic discectomy and posterior discectomy for the treatment of senile single segmental LDH in elderly patients have good curative effect, percutaneous transforaminal endoscopic discectomy hasless trauma, faster recovery and lower postoperative complication rate, but the rate of recurrence is relatively higher, so we need to strictly grasp the indications for surgery.
Objective To compare the therapeutic effect of percutaneous transforaminal endoscopic discectomy on elderly patients with senile single segmental lumbar disc herniation(LDH). Method A total of 273 senile single segment LDH patients from January 2014 to January 2015 in our hospital were selected as study subjects, and they were randomly divided into observation group(n =137) and control group(n = 136). Observation group patients were underwent percutaneous transforaminal endoscopic discectomy and control group patients were underwent posterior microendoscopic discectomy. Observed and compared the therapeutic effect of the two methods on elderly single segment LDH patients. Result There was no significant difference in visual analogue scale(VAS) scores between the two groups before operation(P > 0.05). VAS scores in both groups after operation were significantly lower than those before operation(P < 0.05), and 15 days after operation, VAS score of observation group was significantly lower than control group(P < 0.05). 3 months after operation, there was no significant difference in the VAS scores between the two groups(P > 0.05). The operation time of control group was significantly shorter than that of observation group(P < 0.05), the frequency of intraoperative fluoroscopy was significantly less than that of observation group(P < 0.05), and the amount of bleeding during the operation was significantly more than that of observation group(P < 0.05). The length of the incision, the bed time after operation and hospital stay were significantly longer than those in observation group(P < 0.05). The Oswestry dability index(ODI) scores of the two groups were significantly lower than those before operation(P < 0.05), but there was no significant difference between the two groups in ODI scores before and after operation(P > 0.05). The incidence of postoperative complications in observation group was significantly lower than control group(P < 0.05), but the recurrence rate was significantly higher than control group(P < 0.05). Conclusion Percutaneous transforaminal endoscopic discectomy and posterior discectomy for the treatment of senile single segmental LDH in elderly patients have good curative effect, percutaneous transforaminal endoscopic discectomy hasless trauma, faster recovery and lower postoperative complication rate, but the rate of recurrence is relatively higher, so we need to strictly grasp the indications for surgery.
引文
[1]廖晓龙,徐峰,蔡贤华,等.PELD及MED治疗腰椎间盘突出症的临床比较研究[J].中国中医骨伤科杂志,2014,22(7):29-32.
[2]杨楚枫,蔡贤华,曾晶山.PELD及MED治疗老年单节段腰椎间盘突出症或腰椎管狭窄的临床对比[J].华南国防医学杂志,2016,30(4):253-254,259.
[3]杨林,廖绪强,赵新建,等.经皮椎间孔镜与椎间盘镜下手术治疗腰椎间盘突出症的治疗效果比较[J].中国内镜杂志,2015,21(9):962-965.
[4]Yang XY,Chen ZR,Zhao DC,et al.Clinical efficacy evaluation of needle-knife for lumber disc herniation based on surface electromyography signals[J].Zhongguo Zhen Jiu,2014,34(8):798-800.
[5]吴继彬,葛保健,吴东迎,等.椎板开窗与椎间孔镜治疗腰椎间盘突出症比较[J].中国矫形外科杂志,2016,24(21):1972-1976.
[6]Zhneg SW,Shaikh Atik B,Wang J,et al.Effect of supplementing qi,blood-activating and kidney-nourishing therapy on postoperative recovery in patients with lumber disc herniation[J].Nan Fang Yi Ke Da Xue Xue Bao,2015,35(1):137-140.
[7]金丹杰,徐南伟,赵国辉,等.经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究[J].中国微创外科杂志,2017,17(6):491-494.
[8]徐宝山,马信龙,夏群,等.椎间孔镜TESSYS技术治疗腰椎间盘突出症效果分析[J].天津医药,2014,15(5):470-472.
[9]张铭盛,薛厚军,潘磊,等.经皮椎间孔镜技术治疗腰椎间盘突出症效果分析[J].深圳中西医结合杂志,2017,27(9):133-134.
[10]Xie XJ,Chen RX,Fu Y,et al.Efficacy comparison of lumber disc herniation treated with mild moxibustion at Yaoyangguan(GV 3)under different conditions[J].Zhongguo Zhen Jiu,2014,34(11):1077-1080.
[11]Weber KT,Satoh S,Alipui DO,et al.Exploratory study for identifying systemic biomarkers that correlate with pain response in patients with intervertebral disc disorders[J].Immunol Res,2015,63(1-3):170-180.
[12]陈琳,黄红云,王锐,等.前路减压手术治疗晚期脊髓损伤的初步报告[J].海军总医院学报,2004,17(1):15-18.
[13]谭海涛,孟志斌,李俊,等.经皮椎间孔镜TESSYS技术治疗老年游离型腰椎间盘突出合并腰椎管狭窄症的疗效观察[J].中国医学前沿杂志(电子版),2017,9(8):55-58.
[14]倪欢,冯晶,黄觅,等.经皮椎间孔镜下微创治疗成人腰椎间盘突出症效果观察及其对髓核基质金属蛋白酶-1的影响[J].中国医学前沿杂志(电子版),2017,9(8):59-62.
[15]王平,刘莅彤,王昊,等.经皮椎间孔镜治疗老年腰椎间盘突出症的效果分析[J].中国医学前沿杂志(电子版),2016,8(11):80-83.
[16]隋雨新,冷辉,吴景山,等.微创经皮椎间孔技术治疗老年性腰椎间盘突出症的疗效分析[J].临床医药文献电子杂志,2016,3(40):7967-7968.
[17]Zhao LJ,Jiang WY,Ma WH,et al.Micro-endoscopic discectomy for the treatment of lumbar disc herniation in senile patients over seventy years old[J].Zhongguo Gu Shang,2011,24(10):811-815.
[18]苏其昌,张汉庆,王晓慧,等.显微镜下与传统髓核摘除治疗腰椎间盘突出症疗效的Meta分析[J].江汉大学学报(自然科学版),2017,45(4):348-354.
[19]杨明轩,王栓科,刘昊楠,等.后路椎间盘镜与显微镜下手术治疗腰椎间盘突出症中期疗效分析[J].重庆医学,2015,15(11):1496-1498.
[20]张愈峰,侍德.显微镜下椎间盘切除术与显微内镜下椎间盘切除术治疗老年单节段腰椎间盘突出的疗效对比[J].中国老年学杂志,2016,36(3):661-663.
[2]杨楚枫,蔡贤华,曾晶山.PELD及MED治疗老年单节段腰椎间盘突出症或腰椎管狭窄的临床对比[J].华南国防医学杂志,2016,30(4):253-254,259.
[3]杨林,廖绪强,赵新建,等.经皮椎间孔镜与椎间盘镜下手术治疗腰椎间盘突出症的治疗效果比较[J].中国内镜杂志,2015,21(9):962-965.
[4]Yang XY,Chen ZR,Zhao DC,et al.Clinical efficacy evaluation of needle-knife for lumber disc herniation based on surface electromyography signals[J].Zhongguo Zhen Jiu,2014,34(8):798-800.
[5]吴继彬,葛保健,吴东迎,等.椎板开窗与椎间孔镜治疗腰椎间盘突出症比较[J].中国矫形外科杂志,2016,24(21):1972-1976.
[6]Zhneg SW,Shaikh Atik B,Wang J,et al.Effect of supplementing qi,blood-activating and kidney-nourishing therapy on postoperative recovery in patients with lumber disc herniation[J].Nan Fang Yi Ke Da Xue Xue Bao,2015,35(1):137-140.
[7]金丹杰,徐南伟,赵国辉,等.经皮椎间孔镜与椎板开窗椎间盘切除术治疗腰椎间盘突出症的前瞻性随机对照研究[J].中国微创外科杂志,2017,17(6):491-494.
[8]徐宝山,马信龙,夏群,等.椎间孔镜TESSYS技术治疗腰椎间盘突出症效果分析[J].天津医药,2014,15(5):470-472.
[9]张铭盛,薛厚军,潘磊,等.经皮椎间孔镜技术治疗腰椎间盘突出症效果分析[J].深圳中西医结合杂志,2017,27(9):133-134.
[10]Xie XJ,Chen RX,Fu Y,et al.Efficacy comparison of lumber disc herniation treated with mild moxibustion at Yaoyangguan(GV 3)under different conditions[J].Zhongguo Zhen Jiu,2014,34(11):1077-1080.
[11]Weber KT,Satoh S,Alipui DO,et al.Exploratory study for identifying systemic biomarkers that correlate with pain response in patients with intervertebral disc disorders[J].Immunol Res,2015,63(1-3):170-180.
[12]陈琳,黄红云,王锐,等.前路减压手术治疗晚期脊髓损伤的初步报告[J].海军总医院学报,2004,17(1):15-18.
[13]谭海涛,孟志斌,李俊,等.经皮椎间孔镜TESSYS技术治疗老年游离型腰椎间盘突出合并腰椎管狭窄症的疗效观察[J].中国医学前沿杂志(电子版),2017,9(8):55-58.
[14]倪欢,冯晶,黄觅,等.经皮椎间孔镜下微创治疗成人腰椎间盘突出症效果观察及其对髓核基质金属蛋白酶-1的影响[J].中国医学前沿杂志(电子版),2017,9(8):59-62.
[15]王平,刘莅彤,王昊,等.经皮椎间孔镜治疗老年腰椎间盘突出症的效果分析[J].中国医学前沿杂志(电子版),2016,8(11):80-83.
[16]隋雨新,冷辉,吴景山,等.微创经皮椎间孔技术治疗老年性腰椎间盘突出症的疗效分析[J].临床医药文献电子杂志,2016,3(40):7967-7968.
[17]Zhao LJ,Jiang WY,Ma WH,et al.Micro-endoscopic discectomy for the treatment of lumbar disc herniation in senile patients over seventy years old[J].Zhongguo Gu Shang,2011,24(10):811-815.
[18]苏其昌,张汉庆,王晓慧,等.显微镜下与传统髓核摘除治疗腰椎间盘突出症疗效的Meta分析[J].江汉大学学报(自然科学版),2017,45(4):348-354.
[19]杨明轩,王栓科,刘昊楠,等.后路椎间盘镜与显微镜下手术治疗腰椎间盘突出症中期疗效分析[J].重庆医学,2015,15(11):1496-1498.
[20]张愈峰,侍德.显微镜下椎间盘切除术与显微内镜下椎间盘切除术治疗老年单节段腰椎间盘突出的疗效对比[J].中国老年学杂志,2016,36(3):661-663.