后路脊柱显微内镜下髓核摘除类固醇激素神经根鞘内注射的临床疗效观察

Functional outcomes of posterior microendoscopic discectomy with steroid intrathecal injection in nerve root

目的探讨后路脊柱显微内镜下腰椎椎间盘髓核摘除术(microendoscopy discectomy,MED)中类固醇激素神经根鞘内注射的临床应用效果。方法 2006年3月～2011年3月收治的360例腰椎椎间盘突出患者随机分为2组,MED神经根鞘内注射组治疗180例,后路脊柱显微内镜下摘除突出的髓核组织并在神经根鞘内注入5 mg地塞米松;MED组180例,手术方法相同,但不注射地塞米松。记录2组手术前后疼痛视觉模拟量表(visual analogue scale,VAS)评分、直腿抬高角度及恢复正常工作的时间。结果 MED神经根鞘内注射组术前VAS评分为6.8±0.8,术后VAS评分为2.1±0.4;MED组术前VAS评分为6.7±0.6,术后VAS评分为3.6±0.7,术后2组疼痛均有明显的改善,MED神经根鞘内注射组改善更明显(P<0.01)。MED神经根鞘内注射组直腿抬高术前为28.4°±13.0°,术后为67.0°±12.0°;MED组术前为27.6°±11.0°,术后为51.0°±17.0°,2组术后直腿抬高都有明显改善,MED神经根鞘内注射组改善更明显(P<0.01)。MED神经根鞘内注射组恢复正常生活时间为12 d,MED组为21 d,MED神经根鞘内注射组比MED组恢复时间显著缩短。结果后路脊柱显微内镜能对神经根进行高倍放大,从而进行精确鞘内注射,鞘内注射类固醇激素治疗腰椎椎间盘突出能显著改善术后疼痛、恢复肢体活动范围及更早的恢复日常生活。

Objective To investigate the fimetional outcomes of steroid intrathecal injection in nerve root during posterior microendoscopic discectomly （MH））. Methods Between March 2006 and March 2011 , 360 patients with lumbar disc herni- ation were randomly divided into 2 groups （n = 180）. All the patients underwent posterior MED, meanwhile the patents in the MED with intrathecal injection group received 5 mg dexamethasone. Visual analogue scale （VAS） score, straight leg raising angle and the duration of recovery were reeorded before and ＇after the treatment in both groups. Results In the MED with inlratheeal injection group, VAS scores wete 6.8 ±0.8 and 2.1 ± 0. 4, and straight leg raising angles were 28.4° ± 13.0° and 67.0° ±] 2.0°before and ＇after operation, respeetively. In the MED group, VAS scores were 6.7 ± 0.6 and 3.6 ± 0.7, straight leg raising angles were 27.6° ± 11. 0°and 51.0°±17.0°before and ＇after operation, respectively. Postoperative pain relief and straight leg raising were significantly improved as compared with preoperative indexes in both groups. And there were significant differences between Ihe 2 groups in terms of postoperative VAS scores and straight leg raising angle （ P 〈 0. 01 ）. The duration of recovery to normal daily life in the MED with intratheeal injection group was significantly shorter than the MED group （ 12 d versus 21 d）. Conclusion Posterior microendoscope can amplify the nerve root and allow accurate intrathecal injection. MED with steroid intrathecal injection in the treatment of lumbar disc herniation can effectively relieve the postoperative pain, restore the range of motion and make patients early return to normal life.