椎间盘镜后路摘除术与椎间孔镜下髓核摘除治疗腰椎间盘突出症的疗效对比分析
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摘要
目的:对比运用椎间盘镜后路摘除与椎间孔镜下髓核摘除治疗腰椎间盘突出症的疗效及对患者预后的影响。方法:选取医院收治的194例腰椎间盘突出症患者,采用随机数表法将其分为观察组和对照组,每组97例。对照组采用椎间盘镜后路摘除术治疗,观察组采用椎间孔镜下髓核摘除术,比较两组的临床疗效、各项手术指标水平、手术前后日本骨科协会(JOA)评分、术后复发率以及并发症发生情况。结果:两组手术的优良率比较无明显差异;观察组手术时间明显长于对照组,而术中出血量、术后下床时间及住院时间明显少于对照组,其差异有统计学意义(t=6.172,t=45.052,t=7.613,t=6.307;P<0.05);两组术前、术后3个月、6个月的JOA评分比较,差异均无统计学意义(t=0.306、t=0.979、t=0.547;P>0.05);两组术后复发率、神经损伤率和椎间隙感染率比较,差异均无统计学意义(x~2=1.052,x~2=0.339,x~2=2.021;P>0.05)。结论:椎间盘镜后路摘除治疗腰椎间盘突出症手术时间短,但椎间孔镜下髓核摘除术对患者造成的创伤更小,术后恢复较快,椎间孔镜下髓核摘除术可适用于腰椎间盘突出症。
Objective: To compare the curative effect of posterior discectomy under endoscopy and nucleus pulposus enucleation under endoscopy in treating lumbar disc herniation and the influence of different methods on the prognosis of patients. Methods: 194 patients with lumbar disc herniation were enrolled in this research and were divided into observation group(97 cases) and control group(97 cases) according to random number table. And these patients of control group were treated by using posterior discectomy under endoscopy, and ones of observation group were treated by using nucleus pulposus enucleation under endoscopy. And the clinically curative effect, the level of each surgical indicator, the score of Japanese orthopaedic association(JOA) pre and post operation, postoperative recurrence rate and complication of the two groups were compared. Results: The difference of good rate between two groups was no significant. The operation time of observation group was significantly longer than that of control group, and the amount of bleeding during operation, the time of getting out of bed post operation and the time of hospitalization of observation group were significantly shorter than those of control group(t=6.172, t=45.052, t=7.613, t=6.307, P<0.05). The JOA scores of two groups before operation, and that of 3 months and 6 months after operation were compared, and there were no significant differences between the two groups(t=0.306, t=0.979, t=0.547, P>0.05). Besides, the differences of recurrence rate, nerve injury rate and intervertebral infection rate between the two groups were no significant(x~2=1.052, x~2=0.339, x~2=2.021, P>0.05). Conclusion: The operation time of posterior discectomy under endoscope for lumbar disc herniation is shorter, while the wound of nucleus pulposus enucleation under endoscopy for patients is smaller and its postoperative recovery is faster. And the nucleus pulposus enucleation under endoscopy is suitable for lumbar disc herniation.
Objective: To compare the curative effect of posterior discectomy under endoscopy and nucleus pulposus enucleation under endoscopy in treating lumbar disc herniation and the influence of different methods on the prognosis of patients. Methods: 194 patients with lumbar disc herniation were enrolled in this research and were divided into observation group(97 cases) and control group(97 cases) according to random number table. And these patients of control group were treated by using posterior discectomy under endoscopy, and ones of observation group were treated by using nucleus pulposus enucleation under endoscopy. And the clinically curative effect, the level of each surgical indicator, the score of Japanese orthopaedic association(JOA) pre and post operation, postoperative recurrence rate and complication of the two groups were compared. Results: The difference of good rate between two groups was no significant. The operation time of observation group was significantly longer than that of control group, and the amount of bleeding during operation, the time of getting out of bed post operation and the time of hospitalization of observation group were significantly shorter than those of control group(t=6.172, t=45.052, t=7.613, t=6.307, P<0.05). The JOA scores of two groups before operation, and that of 3 months and 6 months after operation were compared, and there were no significant differences between the two groups(t=0.306, t=0.979, t=0.547, P>0.05). Besides, the differences of recurrence rate, nerve injury rate and intervertebral infection rate between the two groups were no significant(x~2=1.052, x~2=0.339, x~2=2.021, P>0.05). Conclusion: The operation time of posterior discectomy under endoscope for lumbar disc herniation is shorter, while the wound of nucleus pulposus enucleation under endoscopy for patients is smaller and its postoperative recovery is faster. And the nucleus pulposus enucleation under endoscopy is suitable for lumbar disc herniation.
引文
[1]孙利明,智新力,赵志远,等.椎间孔镜下脊柱内固定系统治疗中央型腰椎间盘突出症的效果评价研究[J].中国医学装备,2016,13(5):113-116.
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[3]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.
[4]陈崎,秦练,李名武,等.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[J].中国医学前沿杂志(电子版),2018,10(2):60-64.
[5]徐恒,简伟,谷福顺,等.经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症伴或不伴腰椎神经根管狭窄的疗效观察[J].中国微创外科杂志,2018,18(1):39-42.
[6]董蕊,徐幼苗,张志利,等.经皮椎间孔镜与经侧隐窝入路胶原酶髓核溶解术治疗腰椎间盘突出症的效果对比研究[J].中国医学装备,2018,15(7):63-65.
[7]查圆瑜,杨阳,周逸驰,等.经皮椎间孔镜与Mast Quadrant通道技术治疗腰椎间盘突出症临床疗效比较[J].现代生物医学进展,2017,17(20):3978-3982.
[8]黄勇全,温俭,陈文明,等.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症疗效分析[J].上海医药,2017,38(6):21-24.
[9]成霞,林士明,黄知音,等.经皮椎间孔镜下髓核摘除术后中药热熨敷治疗椎旁肿痛短期临床疗效[J].浙江临床医学,2018,20(3):511-512.
[10]李继锋.经皮椎间孔镜髓核摘除术对腰椎间盘突出症肥胖患者术中出血量及术后VAS评分的影响[J].现代诊断与治疗,2017,29(11):1791-1793.
[11]王冲.经皮椎间孔镜下髓核摘除术对腰椎间盘突出症患者术后疼痛程度及生活质量的影响[J].西南军医,2017,19(6):552-554.
[12]查圆瑜,金伟,张树威,等.经皮椎间孔入路与椎板间入路脊柱内镜下髓核摘除术治疗L5/S1椎间盘突出症的疗效分析[J].生物骨科材料与临床研究,2017,14(1):64-68.
[13]郭麒玉,智勇.经皮椎间孔镜技术对腰椎间盘突出症患者视觉模拟评分Lehmann腰椎功能评分及生活质量评分的影响[J].中国药物与临床,2017,17(10):1515-1517.
[14]欧阳少明,饶放萍,刘辉.经皮椎间孔镜髓核摘除术治疗腰椎间盘突出的临床效果[J].中国当代医药,2017,24(12):53-55.
[15]邢伟园,匡正达,邹小丽,等.经皮椎间孔镜下髓核摘除与开窗髓核摘除治疗腰椎间盘突出症疗效比较的meta分析[J].中华灾害救援医学,2017,5(1):36-40.
[2]辛自刚,邓毅勇.经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症的疗效分析[J].中国现代医生,2018,56(22):87-89.
[3]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.
[4]陈崎,秦练,李名武,等.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[J].中国医学前沿杂志(电子版),2018,10(2):60-64.
[5]徐恒,简伟,谷福顺,等.经皮椎间孔镜TESSYS技术治疗腰椎间盘突出症伴或不伴腰椎神经根管狭窄的疗效观察[J].中国微创外科杂志,2018,18(1):39-42.
[6]董蕊,徐幼苗,张志利,等.经皮椎间孔镜与经侧隐窝入路胶原酶髓核溶解术治疗腰椎间盘突出症的效果对比研究[J].中国医学装备,2018,15(7):63-65.
[7]查圆瑜,杨阳,周逸驰,等.经皮椎间孔镜与Mast Quadrant通道技术治疗腰椎间盘突出症临床疗效比较[J].现代生物医学进展,2017,17(20):3978-3982.
[8]黄勇全,温俭,陈文明,等.经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症疗效分析[J].上海医药,2017,38(6):21-24.
[9]成霞,林士明,黄知音,等.经皮椎间孔镜下髓核摘除术后中药热熨敷治疗椎旁肿痛短期临床疗效[J].浙江临床医学,2018,20(3):511-512.
[10]李继锋.经皮椎间孔镜髓核摘除术对腰椎间盘突出症肥胖患者术中出血量及术后VAS评分的影响[J].现代诊断与治疗,2017,29(11):1791-1793.
[11]王冲.经皮椎间孔镜下髓核摘除术对腰椎间盘突出症患者术后疼痛程度及生活质量的影响[J].西南军医,2017,19(6):552-554.
[12]查圆瑜,金伟,张树威,等.经皮椎间孔入路与椎板间入路脊柱内镜下髓核摘除术治疗L5/S1椎间盘突出症的疗效分析[J].生物骨科材料与临床研究,2017,14(1):64-68.
[13]郭麒玉,智勇.经皮椎间孔镜技术对腰椎间盘突出症患者视觉模拟评分Lehmann腰椎功能评分及生活质量评分的影响[J].中国药物与临床,2017,17(10):1515-1517.
[14]欧阳少明,饶放萍,刘辉.经皮椎间孔镜髓核摘除术治疗腰椎间盘突出的临床效果[J].中国当代医药,2017,24(12):53-55.
[15]邢伟园,匡正达,邹小丽,等.经皮椎间孔镜下髓核摘除与开窗髓核摘除治疗腰椎间盘突出症疗效比较的meta分析[J].中华灾害救援医学,2017,5(1):36-40.