显微镜辅助通道下腰椎间盘髓核摘除术治疗腰椎间盘突出症的效果
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摘要
目的探讨显微镜辅助通道下腰椎间盘髓核摘除术(MSLD)治疗腰椎间盘突出症(LDH)的效果。方法选取2016年2月～2018年4月粤北人民医院收治的LDH患者105例。根据手术方法的不同将患者分为椎板间入路经皮穿刺脊柱内镜腰椎间盘摘除术(IL-PELD)组(n=52,给予IL-PELD术式)和MSLD组(n=53,给予MSLD术式),记录两组患者手术时间、术中出血量、手术切口长度、术中透视次数、术后住院时间、并发症发生率。观察两组患者治疗后临床疗效。记录两组患者术前、术后1 d、术后1个月、术后3个月、术后6个月的视觉模拟评分(VAS)、Osweatry功能障碍指数(ODI)评分情况。结果两组患者手术切口长度、术后住院时间比较差异无统计学意义(P> 0.05)。MSLD组手术时间长于IL-PELD组,术中出血量、术中透视次数少于IL-PELD组,并发症发生率低于IL-PELD组(P <0.05)。两组临床总有效率比较差异无统计学意义(P> 0.05)。两组患者术前、术后1 d、术后1个月、术后3个月、术后6个月VAS、ODI评分同期比较差异无统计学意义(P> 0.05)。两组患者术后1 d、术后1个月、术后3个月、术后6个月VAS、ODI评分均较术前降低,且各时间点呈依次下降趋势(P <0.05)。结论与传统手术比较,MSLD治疗LDH,虽然获得的疗效相当,但其可以有效减少术中出血量、术中透视次数,降低并发症发生率,值得进一步的临床推广。
Objective To investigate the effect of microscopically assisted lumbar discectomy(MSLD) in the treatment of lumbar disc herniation(LDH). Methods One hundred and five cases of LDH admitted to Yuebei People′s Hospital from February 2016 to April 2018 were selected. The patients were divided into percutaneous intervertebral disc percutaneous endoscopic lumbar discectomy(IL-PELD) group(n = 52, given IL-PELD) and MSLD group(n = 53, given MSLD). The operation time, intraoperative bleeding volume, incision length, fluoroscopy times, hospitalization time and complication rate were recorded. The clinical efficacy of the two groups after treatment was observed. The visual analogue score(VAS) and Osweatry dysfunction index(ODI) were recorded before operation, 1 d, 1 month, 3 months and6 months after operation. Results There was no significant difference in incision length and hospitalization time after operation between two groups(P > 0.05). The operation time of MSLD group was longer than that of IL-PELD group;the amount of bleeding, the number of fluoroscopy in MSLD group were less than those in IL-PELD group; the incidence of complication in MSLD group was lower than that in IL-PELD group(P < 0.05). The total effective rate of two groups was not statistically significant(P > 0.05). There was no significant difference in VAS and ODI scores between two groups before operation, 1 d after operation, 1 month after operation, 3 months after operation and 6 months after operation at the same period(P > 0.05). The VAS and ODI scores of two groups were lower than those 1 d, 1 month, 3 months and 6 months after the operation, and presented a trend of decrease with time(P < 0.05). Conclusion Compared with the traditional operation, MSLD can effectively reduce the amount of bleeding, the number of fluoroscopy and the incidence of complications. It is worthy of further clinical application.
Objective To investigate the effect of microscopically assisted lumbar discectomy(MSLD) in the treatment of lumbar disc herniation(LDH). Methods One hundred and five cases of LDH admitted to Yuebei People′s Hospital from February 2016 to April 2018 were selected. The patients were divided into percutaneous intervertebral disc percutaneous endoscopic lumbar discectomy(IL-PELD) group(n = 52, given IL-PELD) and MSLD group(n = 53, given MSLD). The operation time, intraoperative bleeding volume, incision length, fluoroscopy times, hospitalization time and complication rate were recorded. The clinical efficacy of the two groups after treatment was observed. The visual analogue score(VAS) and Osweatry dysfunction index(ODI) were recorded before operation, 1 d, 1 month, 3 months and6 months after operation. Results There was no significant difference in incision length and hospitalization time after operation between two groups(P > 0.05). The operation time of MSLD group was longer than that of IL-PELD group;the amount of bleeding, the number of fluoroscopy in MSLD group were less than those in IL-PELD group; the incidence of complication in MSLD group was lower than that in IL-PELD group(P < 0.05). The total effective rate of two groups was not statistically significant(P > 0.05). There was no significant difference in VAS and ODI scores between two groups before operation, 1 d after operation, 1 month after operation, 3 months after operation and 6 months after operation at the same period(P > 0.05). The VAS and ODI scores of two groups were lower than those 1 d, 1 month, 3 months and 6 months after the operation, and presented a trend of decrease with time(P < 0.05). Conclusion Compared with the traditional operation, MSLD can effectively reduce the amount of bleeding, the number of fluoroscopy and the incidence of complications. It is worthy of further clinical application.
引文
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[10]刘继波,李江龙,谢大伟,等.不同手术方案治疗腰椎间盘突出症合并腰椎失稳临床对比研究[J].中国现代医学杂志,2018,28(19):107-111.
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[12]陈远明,万健,黄中飞,等.改良椎间孔镜技术治疗腰椎间盘突出症的疗效分析[J].中国内镜杂志,2018,24(4):1-5.
[13] Xia W,Zhang LL,Mo J,et al. Effect of static compression loads on intervertebral disc:an in vivo bent rat tail model[J]. Orthop Surg,2018,10(2):134-143.
[14] Dalbayrak S,Yaman O,Yilmaz M,et al. Transforaminal approach in lumbar disc herniations:transforaminal microdiscectomy(TFMD)technique[J]. Turk Neurosurg,2015,25(1):29-35.
[15]朱如森,张学利,万军,等.显微镜下微创椎间盘取出术治疗腰椎间盘突出症疗效观察[J].山东医药,2015,55(10):59-61.
[16]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,2015,44(11):1496-1498.
[17]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.
[18] Byval'tsev VA,Panasenkov SIu,Tsyganov PIu,et al. Nanostructural analysis of the lumbar intervertebral disc on the various stages of degenerative process[J]. Zh Vopr Neirokhir Im N N Burdenko,2013,77(3):36-40.
[19]郁凯,杨忠,李爱民,等.经皮椎间孔镜下髓核摘除术和显微镜下髓核摘除术治疗腰椎间盘突出症的疗效比较[J].中国全科医学,2018,21(z1):20-22.
[20] Matveeva N,Zivadinovik J,Zdravkovska M,et al. Histological composition of lumbar disc herniations related to the type of herniation and to the age[J]. Bratisl Lek Listy,2012,113(12):712-717.
[2]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.
[3]张雷,田永昊,刘新宇,等.腰椎后路微创髓核摘除术后切口感染的风险因素分析[J].临床骨科杂志,2017,20(4):419-423.
[4]胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012:11-15.
[5]董进文,赵迅霞.汉化Oswestry功能障碍指数评价老年腰椎间盘突出症介入治疗术后疗效[J].西部医学,2013,25(4):623-624,627.
[6]王翀,田征,梁青福,等.经皮椎间孔镜TESSYS技术治疗单节段腰椎间盘突出症60例分析[J].中国内镜杂志,2016,22(1):32-36.
[7] Tao XZ,Jing L,Li JH. Therapeutic effect of transforaminal endoscopic spine system in the treatment of prolapse oflumbar intervertebral disc[J]. Eur Rev Med Pharmacol Sci,2018,22(1 Suppl):103-110.
[8] Onyia CU,Menon SK. The debate on most ideal technique for managing recurrent lumbar disc herniation:a short review[J]. Br J Neurosurg,2017,31(6):701-708.
[9]曹越,章薇.针药结合对寒湿证腰椎间盘突出症患者血清IL-6和TNF-α的影响[J].针灸临床杂志,2016,32(1):8-10.
[10]刘继波,李江龙,谢大伟,等.不同手术方案治疗腰椎间盘突出症合并腰椎失稳临床对比研究[J].中国现代医学杂志,2018,28(19):107-111.
[11]黄保华,陈远明,周先明,等.经椎间孔经皮内镜治疗复发性腰椎间盘突出症[J].中国微创外科杂志,2016,16(9):820-823,832.
[12]陈远明,万健,黄中飞,等.改良椎间孔镜技术治疗腰椎间盘突出症的疗效分析[J].中国内镜杂志,2018,24(4):1-5.
[13] Xia W,Zhang LL,Mo J,et al. Effect of static compression loads on intervertebral disc:an in vivo bent rat tail model[J]. Orthop Surg,2018,10(2):134-143.
[14] Dalbayrak S,Yaman O,Yilmaz M,et al. Transforaminal approach in lumbar disc herniations:transforaminal microdiscectomy(TFMD)technique[J]. Turk Neurosurg,2015,25(1):29-35.
[15]朱如森,张学利,万军,等.显微镜下微创椎间盘取出术治疗腰椎间盘突出症疗效观察[J].山东医药,2015,55(10):59-61.
[16]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,2015,44(11):1496-1498.
[17]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.
[18] Byval'tsev VA,Panasenkov SIu,Tsyganov PIu,et al. Nanostructural analysis of the lumbar intervertebral disc on the various stages of degenerative process[J]. Zh Vopr Neirokhir Im N N Burdenko,2013,77(3):36-40.
[19]郁凯,杨忠,李爱民,等.经皮椎间孔镜下髓核摘除术和显微镜下髓核摘除术治疗腰椎间盘突出症的疗效比较[J].中国全科医学,2018,21(z1):20-22.
[20] Matveeva N,Zivadinovik J,Zdravkovska M,et al. Histological composition of lumbar disc herniations related to the type of herniation and to the age[J]. Bratisl Lek Listy,2012,113(12):712-717.