经皮椎间孔镜腰椎间盘切除术和椎板开窗腰椎间盘切除术治疗腰椎间盘突出症的优劣差异
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摘要
目的探讨经皮椎间孔镜腰椎间盘切除术(PELD)和椎板开窗腰椎间盘切除术治疗腰椎间盘突出症的优劣差异。方法选取2017年1月～2018年1月于我院收治的120例腰椎间盘突出症患者,依据住院顺序随机分为观察组和对照组,每组60例,观察组行PELD,对照组行椎板开窗腰椎间盘切除术,术后随访6个月,观察两组患者手术切口长度、手术时间、术中出血量、术后卧床时间和术后住院时间,比较两组患者治疗前后的疼痛情况(VAS评分)及生活质量(ODI指数)情况,并比较两组患者治疗6个月后的临床疗效(MacNab优良率)。结果两组患者的手术时间比较差异无统计学意义(P> 0.05),观察组的切口长度、术中出血量、术后卧床时间及术后住院时间均明显小于对照组,差异有统计学意义(P <0.05);两组患者治疗后任一时间点的VAS评分和ODI指数均明显低于治疗前,差异有统计学意义(P <0.05),治疗后1周及1、3、6个月,观察组患者的VAS评分和ODI指数均分别低于对照组,差异有统计学意义(P <0.05),术后随访6个月,观察组患者术后的临床疗效(MacNab优良率91.67%)明显优于对照组(MacNab优良率78.33%),差异有统计学意义(P <0.05)。结论经皮椎间孔镜腰椎间盘切除手术创伤小,术后恢复快,能明显减轻患者疼痛程度,改善患者术后生活质量,其临床疗效显著。
Objective To explore the differences in advantages and disadvantages of percutaneous endoscopic lumbar discectomy(PELD) and vertebral lamina fenestration lumbar discectomy in the treatment of Lumbar disc herniation. Methods 120 patients with lumbar disc herniation who were admitted to our hospital from January 2017 to January 2018 were selected. According to the hospitalization order, they were randomly divided into observation group and control group, with 60 cases in each group.The observation group underwent PELD while the control group underwentvertebral lamina fenestration lumbar discectomy.The patients were followed up for 6 months after operation.The length of the incision,the operation time,the intraoperative blood loss,postoperative bed rest time and postoperative hospital stay of patients in two groups were observed.The pain(VAS score) and quality of life(ODI index) before and after treatment were compared between the two groups,and the clinical curative effect(MacNab excellent and good rate) of 6 months after treatment was compared between the two groups. Results There was no significant difference in the operation time between the two groups(P > 0.05).The incision length,intraoperative blood loss,postoperative bed rest time and postoperative hospital stay in the observation group were significantly lower than those in the control group(P < 0.05).The VAS score and ODI index of the two groups at any time after treatment were significantly lower than those before treatment(P < 0.05).At 1 week and 1,3,and 6 months after treatment,the VAS score and ODI index of the observation group were lower than those of the control group(P < 0.05).After 6 months of follow-up,the clinical curative effect of the observation group(MacNab excellent and good rate was 91.67%) was significantly better than the control group MacNab excellent and good rate was 78.33%)(P < 0.05). Conclusion Percutaneous endoscopic lumbar discectomyhas smallincision length andfast postoperative recovery.It can significantly reduce the pain of patients and improve the quality of life of patients after surgery,and its clinical curative effect is significant.
Objective To explore the differences in advantages and disadvantages of percutaneous endoscopic lumbar discectomy(PELD) and vertebral lamina fenestration lumbar discectomy in the treatment of Lumbar disc herniation. Methods 120 patients with lumbar disc herniation who were admitted to our hospital from January 2017 to January 2018 were selected. According to the hospitalization order, they were randomly divided into observation group and control group, with 60 cases in each group.The observation group underwent PELD while the control group underwentvertebral lamina fenestration lumbar discectomy.The patients were followed up for 6 months after operation.The length of the incision,the operation time,the intraoperative blood loss,postoperative bed rest time and postoperative hospital stay of patients in two groups were observed.The pain(VAS score) and quality of life(ODI index) before and after treatment were compared between the two groups,and the clinical curative effect(MacNab excellent and good rate) of 6 months after treatment was compared between the two groups. Results There was no significant difference in the operation time between the two groups(P > 0.05).The incision length,intraoperative blood loss,postoperative bed rest time and postoperative hospital stay in the observation group were significantly lower than those in the control group(P < 0.05).The VAS score and ODI index of the two groups at any time after treatment were significantly lower than those before treatment(P < 0.05).At 1 week and 1,3,and 6 months after treatment,the VAS score and ODI index of the observation group were lower than those of the control group(P < 0.05).After 6 months of follow-up,the clinical curative effect of the observation group(MacNab excellent and good rate was 91.67%) was significantly better than the control group MacNab excellent and good rate was 78.33%)(P < 0.05). Conclusion Percutaneous endoscopic lumbar discectomyhas smallincision length andfast postoperative recovery.It can significantly reduce the pain of patients and improve the quality of life of patients after surgery,and its clinical curative effect is significant.
引文
[1]柳百炼,熊鹰,顾邵,等.经皮椎间孔镜治疗腰椎间盘突出症的临床效果[J].实用医学杂志,2015,41(6):981-983.
[2]杨五洲,曹奇,杨铁军,等.经皮椎间孔镜治疗腰椎间盘突出症的临床应用[J].实用医学杂志,2016,32(4):633-635.
[3]韩康,高浩然,卞娜,等.经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症临床疗效比较[J].中华全科医学,2015,13(6):868-871,封3.
[4]符祖昶,王清铿,尤瑞金,等.经皮椎间孔镜治疗腰椎间盘突出症的临床效果[J].中国医药导报,2017,14(18):80-83.
[5]李广松,乔荣慧,刘伟,等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄[J].中国微创外科杂志,2015,20(6):522-526.
[6]江涛.微创与椎板开窗技术治疗腰椎间盘突出症的临床疗效比较[J].实用临床医药杂志,2014,18(3):46-48.
[7]赵锡武,韩康,刘鑫,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较[J].现代生物医学进展,2015,15(14):2692-2695,2706.
[8]高国勇,陈廖斌,镇万新,等.经皮椎间孔镜微创技术治疗腰椎间盘突出症[J].中华显微外科杂志,2012,31(5):423-425.
[9]徐仲林,蒋赞利.经皮椎间孔镜技术的发展、治疗范围、并发症及特点[J].东南大学学报(医学版),2015,26(3):452-455.
[10]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.
[11]田永刚,王铜浩,韩立强,等.经皮椎间孔镜靶向穿刺分步法治疗腰椎间盘突出症效果分析[J].天津医药,2015,43(8):905-908.
[12]周跃,李长青,王建,等.经皮椎间孔镜治疗极外侧型腰椎间盘突出症的临床效果评价[J].中华创伤杂志,2009,25(8):698-704.
[13]方卫军,李章华.经皮椎间孔镜技术治疗腰椎间盘突症的进展[J].中国医药导报,2016,13(32):34-37.
[14]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.
[15]崔维,林欣,王磊,等.经皮椎间孔镜与开放性手术治疗腰椎间盘突出症的疗效对比[J].中国临床医生,2014,(4):60-62.
[2]杨五洲,曹奇,杨铁军,等.经皮椎间孔镜治疗腰椎间盘突出症的临床应用[J].实用医学杂志,2016,32(4):633-635.
[3]韩康,高浩然,卞娜,等.经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症临床疗效比较[J].中华全科医学,2015,13(6):868-871,封3.
[4]符祖昶,王清铿,尤瑞金,等.经皮椎间孔镜治疗腰椎间盘突出症的临床效果[J].中国医药导报,2017,14(18):80-83.
[5]李广松,乔荣慧,刘伟,等.经椎间孔脊柱内窥镜技术治疗腰椎间盘突出症合并神经根管狭窄[J].中国微创外科杂志,2015,20(6):522-526.
[6]江涛.微创与椎板开窗技术治疗腰椎间盘突出症的临床疗效比较[J].实用临床医药杂志,2014,18(3):46-48.
[7]赵锡武,韩康,刘鑫,等.经皮椎间孔镜与椎板开窗髓核摘除术治疗腰椎间盘突出症的临床疗效比较[J].现代生物医学进展,2015,15(14):2692-2695,2706.
[8]高国勇,陈廖斌,镇万新,等.经皮椎间孔镜微创技术治疗腰椎间盘突出症[J].中华显微外科杂志,2012,31(5):423-425.
[9]徐仲林,蒋赞利.经皮椎间孔镜技术的发展、治疗范围、并发症及特点[J].东南大学学报(医学版),2015,26(3):452-455.
[10]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.
[11]田永刚,王铜浩,韩立强,等.经皮椎间孔镜靶向穿刺分步法治疗腰椎间盘突出症效果分析[J].天津医药,2015,43(8):905-908.
[12]周跃,李长青,王建,等.经皮椎间孔镜治疗极外侧型腰椎间盘突出症的临床效果评价[J].中华创伤杂志,2009,25(8):698-704.
[13]方卫军,李章华.经皮椎间孔镜技术治疗腰椎间盘突症的进展[J].中国医药导报,2016,13(32):34-37.
[14]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.
[15]崔维,林欣,王磊,等.经皮椎间孔镜与开放性手术治疗腰椎间盘突出症的疗效对比[J].中国临床医生,2014,(4):60-62.