椎间孔镜下髓核摘除术治疗腰椎间盘突出症的疗效

Efficacy of transforaminal endoscopic removal of nucleus pulposus in the treatment of patients with lumbar disc herniation

目的探讨椎间孔镜下髓核摘除术治疗腰椎间盘突出症的疗效。方法采用随机数字表法将80例腰椎间盘突出症患者分为A、B两组，每组40例，A组采用椎间孔镜技术，B组采用盘内射频热凝联合胶原酶溶解术。记录术前、术后1d、术后1个月、术后3个月及术后6个月时的疼痛视觉模拟评分（VAS），采用简易MacNab标准评定疗效。结果与术前比较，A、B两组术后各时点VAS评分均下降（P〈0．05）；与B组比较，A组术后各时点VAS评分下降更明显（P〈0．05）。术后1d与1个月时A组VAS评分3以下者分别为30例和34例，明显高于B组的8例和21例（P〈0．05）。术后6个月时A组优良率87．5％（35／40例），B组优良率80．0％（32／40例）。结论椎间孔镜下髓核摘除术与盘内射频热凝联合胶原酶溶解术治疗腰椎间盘突出症效果均好，但前者起效更快，术后疼痛缓解更明显。

Objective To explore the clinical efficacy of transforaminal endoscopic removal of nucleus pulposus in treating the patients with lumbar disc herniation. Methods Eighty patients with lumbar herniation were divided into two groups, 40 cases in each group, group A： percutaneous endoscopic lumbar removal of nucleus pulposus, PELD; group B： target radiofrequency combined with collagenase chemonucleolysis. Visual analogue scale （VAS）and MacNab standard was adopted to evaluate the analgesic and curative effects in the preoperative period and 1 day, 1 month, 3 months, and 6 months after operation. Results The clinical pain symptoms in the two groups were all relieved obviously after operation. In group A, the VAS decreased from （7.3 ±1.6）before operation to （ 1.3 ± 0.5 ）at 6 months after operation. In group B, the VAS decreased from （7.3 ± 1.6）before operation to （2.2 ±0.5） at 6 months after operation. Compared with group B, VAS in group A were significantly lower at 1 day, 1 month, 3 months and 6 months after operation （P〈 0.05）. Six months after operation the excellent and good rate in group A （87.5% , 35/40 cases）was much higher than that in group B （80.0%, 32/40 cases） , but with no statistical difference （P〉 0.05）. Conclusion Both transforaminal endoscopic removal of nucleus pulposus and the target radiofrequency combined with collagenase chemonucleolysis are of good clinical efficacy in the treatment of lumbar disc herniation,but the former with quicker onset to alleviate the pain.