两种体位下经皮穿刺激光气化减压术治疗腰椎间盘突出症的比较

Comparative Study on Clinical Efficacies of Percutaneous Laser Disc Decompression with Prone Position and Lateral Recumbent Position

目的探讨侧卧体位和俯卧体位在经皮穿刺激光气化减压术中的应用,比较两种穿刺方法的优缺点。方法椎间盘突出患者225例,采用随机前瞻性分组方法分为两组,A组为俯卧位组116例和B组为侧卧位组109例。两组患者均在局部麻醉下经"C"型臂引导行经皮穿刺激光气化减压术。术后随访3个月,观察穿刺时间、治疗前后腿痛的视觉分析评分(visual analogue scale/Score,VAS)评分、腰痛的VAS评分,Oswestry功能障碍指数。结果两组术后3个月腰、腿VAS疼痛评分和ODI评分较术前明显缓解(P<0.05),但A、B组手术时间、VAS评分和ODI评分比较,差异无显著意义(P>0.05),两组患者疗效比较,差异无显著意义(P>0.05),两组术中不适比较,差异具有显著意义(P<0.05)。结论侧卧位治疗适用于术中耐受能力差和需给予臭氧注射的患者,俯卧位适合于髓核突出较大需双侧穿刺和L5-S1椎间盘突出的患者。两种体位下经皮穿刺激光气化减压术治疗腰椎间盘突出症的方法安全、可行,术后短期疗效显著。

Objective To investigate the application of lateral position and prone position in percutaneous laser disc decompression （PLDD） and compare the short-term clinical effects of these two positions. Methods The method of prospective random grouping was adopted. Altogether 225 patients of disc herniation were divided into two groups： the prone position group with 116 patients, and lateral position group with 109 patients. All the patients were given percutane ous laser vaporization decompression via ＂C＂-arm boot line under local anesthesia. The operation duration, leg pain visual analogue scale/Score （VAS） scores before and after surgery, low back pain VAS score, and Oswestry disability index were observed and recor- ded. Results For both the groups, the waist and leg VAS pain scores and ODI scores dropped significantly 3 months after the operation （ P 〈 0.05）. Nevertheless, the difference between them in operative duration, preoperative and postoperative March VAS score, preopera- tive and postoperative 3 months＇ODl score were not significant （P 〉 0. 05）. Moreover, there is no significant difference （P 〉0. 05 between them in satisfaction rate of patients. Conclusions The differences between the percutaneous laser vaporization decompression with lateral position and that with prone posi- tion were not significant in feasibility, safety and short-term efficacy. While lateral position being fit for patients who cannot bear prone position and needs ozone injection, prone position is appropriate for patients with greater herniated nucleus and in need of bilateral puncture.