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

Analysis of the effect of percutaneous endoscopic discectomy in the treatment of lumbar disc herniation

目的:探讨经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的效果。方法:收集2012年9月至2015年2月收治的腰椎间盘突出症患者82例,随机分为试验组和对照组各41例。试验组行经皮椎间孔镜下髓核切除术,对照组行小切口椎板间开窗髓核摘除术。术后随访12个月,观察患者视觉模拟评分(VAS)、手术时间、术中出血量、手术切口长度、Oswestry功能障碍指数评分、JOA评分、血液流变学变化及不良反应发生情况。结果:两组治疗后VAS评分和Oswestry功能障碍指数评分均低于治疗前(P<0.05)。试验组术中出血量、手术切口长度、术后住院时间均低于对照组,差异有统计学意义(P<0.05)。试验组治疗后Oswestry功能障碍指数评分低于对照组(P<0.05)。试验组治疗总优良率为90.24%(37/41),对照组为58.54%(24/41),组间差异有统计学意义(P<0.05)。两组治疗后JOA评分均高于治疗前(P<0.05),试验组JOA评分高于对照组(P<0.05)。试验组治疗后全血粘度、血浆粘度、红细胞压积、红细胞沉降率、红细胞聚集指数、红细胞刚性指数、红细胞变形指数均低于对照组(P均<0.05)。试验组出现术后一过性下肢疼痛过敏1例(2.44%),对照组出现2例(4.88%),差异无统计学意义(P>0.05)。结论:经皮椎间孔镜下髓核摘除术治疗腰椎间盘突出症的效果较好,患者VAS评分、手术时间、术中出血量、手术切口长度、Oswestry功能障碍指数评分较低,JOA评分较高,血液流变学改善较好,无其他明显不良反应,临床应用价值较高。

ABSTRACT Objective： To study the effect of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation. Methods： A total of 82 cases of lumbar disc herniation treated from August 2012 to Feb. were collected and randomly divided into an experimental group and a control group with 41 cases each. The experimental group underwent percutaneous transforaminal endoscopic discectomy and the control group was treated with small incision fenestration diseectomy. After operation, the patients were followed up for 12 months. The visual analogue scale （VAS）, operation time, intraoperative blood loss, incision length, Oswestry dysfunction index score, JOA score, blood theology and adverse reaction were observed in the patients. Results： After treatment, the VAS score and Oswestry index score of the two groups were lower than those before treatment（P〈0.05）. In the experimental group, the amount of bleeding, the length of incision and the length of hospital stay were lower than those of the control group and the difference was statistically significant（P〈0.05）. The score of Oswestry dysfunction index in the experimental group was lower than that in the control group（P〈0.05）. The excellent and good rate of the experimental group was 90.24%（37/41） and that of the control group was 58.54%（24/41） and the difference between the two groups was statistically significant（P〈0.05）. The JOA scores of the two groups after treatment were higher than those before treatment（P〈0.05） and the JOA score of the experimental group was higher than that of the control group（P〈0.05）. After treatment, the whole blood viscosity, plasma viscosity, hematoerit, erythrocyte sedimentation rate, erythroeyte aggregation index, erythrocyte rigidity index and erythrocyte deformability index of the experimental group were lower than those of the control group（P〈0.05）. In the experimental group, 1 case of transient lower limb pain was found （2.44%） and 2 cases （4.88%） in the control group and the difference was not statistically significant（P〉0.05）. Conclusion： Percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation is better. The VAS score, operative time, intraoperative blood loss, incision length and Oswestry dysfunction index score are lower, the JOA score is higher, and the hemorheology is better. There are no other obvious adverse reactions and clinical application value is high.