PTED技术辅以硬膜外注射在脱出型腰椎间盘突出症的可行性分析
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摘要
目的在经皮椎间孔镜下椎间盘切除术(percutaneous transforaminal endoscopicdiscectomy,PTED)治疗脱出型腰椎间盘突出症过程中,探讨辅以硬膜外注射的可行性。方法自2014-08-2015-08行PTED手术治疗脱出型腰椎间盘突出症患者80例,其中37例术中辅以硬膜外注射药物(2 ml甲钴胺+1 ml复方倍他米松注射液+1 ml利多卡因),作为A组;另43例仅予以PTED手术治疗,作为B组。观察两组患者的术后疗效,并进行组间对比。结果两组术后均获随访20-29个月,平均25.1个月,腰腿疼痛和功能障碍均有显著改善,手术前后差异有统计学意义(P<0.05)。组间比较,A组术后1 d、7 d和1个月的VAS评分、ODI指数均显著低于B组(P<0.05);但两组末次随访时的上述指标和优良率差异均无统计学意义(P>0.05)。结论将硬膜外注射药物用于辅助PTED技术治疗脱出型腰椎间盘突出症,可有效减轻其术后早期疼痛,促进功能障碍的尽早恢复。
Objective To explore the feasibility of epidural injection in the treatment of prolapsed lumbar disc herniation by percutaneous transforaminal endoscopic discectomy(PTED).Methods From August 2014 to August 2015,80 patients with prolapsed lumbar intervertebral disc herniation were treated with PTED.Group A(37 patients)was treated with epidural injection(2 ml methylcobalamin+1 ml compound betamethasone injection+1 ml lidocaine),and group B(43patients)was treated with PTED only.The postoperative efficacy of the two groups was observed and compared.ResultsThe patients were followed up for 20-29 months,with an average of 25.1 months.The pain and dysfunction of lumbar and leg were significantly improved.The difference was statistically significant between before and after operation(P<0.05).The VAS score and ODI index of group A were significantly lower than those of group B at 1 day,7 days and 1 month after operation(P<0.05),but there was no significant difference between the two groups at the last follow-up(P>0.05).ConclusionEpidural injection of drugs in the treatment of prolapsed lumbar intervertebral disc herniation with PTED can effectively relieve the early postoperative pain and promote the early recovery of dysfunction.
Objective To explore the feasibility of epidural injection in the treatment of prolapsed lumbar disc herniation by percutaneous transforaminal endoscopic discectomy(PTED).Methods From August 2014 to August 2015,80 patients with prolapsed lumbar intervertebral disc herniation were treated with PTED.Group A(37 patients)was treated with epidural injection(2 ml methylcobalamin+1 ml compound betamethasone injection+1 ml lidocaine),and group B(43patients)was treated with PTED only.The postoperative efficacy of the two groups was observed and compared.ResultsThe patients were followed up for 20-29 months,with an average of 25.1 months.The pain and dysfunction of lumbar and leg were significantly improved.The difference was statistically significant between before and after operation(P<0.05).The VAS score and ODI index of group A were significantly lower than those of group B at 1 day,7 days and 1 month after operation(P<0.05),but there was no significant difference between the two groups at the last follow-up(P>0.05).ConclusionEpidural injection of drugs in the treatment of prolapsed lumbar intervertebral disc herniation with PTED can effectively relieve the early postoperative pain and promote the early recovery of dysfunction.
引文
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[6]张礼礼,毕霞.早期疼痛管理对腰椎间盘突出症患者术后功能锻炼的影响[J].河北医药,2018,(17):2715-2717,2720.
[7]包先昌,谢伟青.玻璃酸钠联合复方倍他米松治疗膝关节骨性关节炎疗效评价[J].中国药业,2018,(11):61-63.
[8]杨秦予,周美宁.甲钴胺与维生素B12治疗早期脊髓亚急性联合变性临床研究[J].陕西医学杂志,2018,(7):920-922,926.
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[10]岳喜军.椎间盘镜下髓核摘除术中联合硬膜外注射曲安奈德和玻璃酸钠治疗腰椎间盘突出症的疗效[J].江苏医药,2016,42(11):1261-1264.
[11]张仲道,李世平,刘迎春,等.联合治疗腰椎间盘突出症98例临床分析[J].颈腰痛杂志,2001,22(3):220-222.
[2]耿洋.经皮椎间孔镜技术治疗极外侧型腰椎间盘突出症的疗效观察[J].颈腰痛杂志,2018,39(4):527-528.
[3]阮朝阳,曾强华,朱群威.口服消栓口服液和甲钴胺胶囊治疗腰椎间盘突出症经皮椎间孔镜术后下肢残留神经症状[J].中医正骨,2015,12:71-72.
[4]Macnab I.Negative disc exploration.An analysis of the causes of Nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg(Am),1971,53(5):891-903.
[5]雷华平,陈建华,张万桂,等.腰椎间盘突出症非手术治疗现状[J].湖北中医药大学学报,2018,(3):126-128,封3.
[6]张礼礼,毕霞.早期疼痛管理对腰椎间盘突出症患者术后功能锻炼的影响[J].河北医药,2018,(17):2715-2717,2720.
[7]包先昌,谢伟青.玻璃酸钠联合复方倍他米松治疗膝关节骨性关节炎疗效评价[J].中国药业,2018,(11):61-63.
[8]杨秦予,周美宁.甲钴胺与维生素B12治疗早期脊髓亚急性联合变性临床研究[J].陕西医学杂志,2018,(7):920-922,926.
[9]段丽群,张文志,刘鹏飞,等.经皮椎间孔镜技术治疗极外侧型腰椎间盘突出症[J].颈腰痛杂志,2016,37(3):214-218.
[10]岳喜军.椎间盘镜下髓核摘除术中联合硬膜外注射曲安奈德和玻璃酸钠治疗腰椎间盘突出症的疗效[J].江苏医药,2016,42(11):1261-1264.
[11]张仲道,李世平,刘迎春,等.联合治疗腰椎间盘突出症98例临床分析[J].颈腰痛杂志,2001,22(3):220-222.