经皮内镜椎板间入路手术联合硬膜外注射治疗脱出型腰椎间盘突出症

Combination treatment of percutaneous endoscopic interlaminar discectomy and epidural in-jection for prolapsed lumbar disc herniation

目的评价经皮内镜椎板间入路椎间盘切除术(PEID)联合硬膜外注射治疗脱出型腰椎间盘突出症(PLDH)的疗效。方法将114例单节段PLDH患者随机分为两组,A组(57例)行PEID后注入4 ml生理盐水,B组(57例)行PEID后注入1 ml复方倍他米松+1 ml利多卡因+2 ml甲钴胺。比较两组并发症情况、术后住院时间、恢复工作时间以及术后疼痛VAS评分和JOA评分。按改良Mac Nab功能评价标准评定疗效。结果患者均获得随访,时间6~30个月。两组均未出现并发症。术后行MRI复查显示髓核均彻底摘除。术后住院时间及恢复工作时间B组均短于A组,差异均有统计学意义(P<0.001)。术后各时段VAS评分、JOA评分两组均较术前明显改善,差异均有统计学意义(P<0.05)。术后1 d、1周、1个月的疼痛VAS评分及JOA评分B组均优于A组,差异均有统计学意义(P<0.001)。术后6个月时两组疼痛VAS评分及JOA评分比较差异无统计学意义(P>0.05)。术后6个月时按照改良Mac Nab功能评价标准评定疗效:A组优38例,良17例,可2例,优良率96%;B组优36例,良19例,可2例,优良率96%;两组优良率比较差异无统计学意义(P>0.05)。结论 PEID治疗PLDH创伤小、疼痛缓解明显、功能恢复好。术中联合使用硬膜外注射短期内疼痛缓解及功能改善更加显著,是一种安全有效的手段。

Objective To assess the effect of combination treatment of percutaneous endoscopic interlaminar discec- tomy（PEID） and epidural injection for prolapsed lumbar disc herniation （PLDH）. Methods The clinical data of 114 patients with single-level PLDH who had undergone PEID were analyzed. The patients were randomly divided into two groups, 57 patients in group A were treated with 4 ml saline after PEID, 57 patients in group B were subjected to an epidural injection of I ml diprospan ＋ 1 ml lidocaine and 2 ml mecobalamine after PEID. Complications, the post- operative hospital stay, recovery time, VAS and JOA scores were compared, and the outcomes were evaluated accord- ing to modified MacNab criteria. Results All the patients were followed up from 6 months to 30 months. All the op- erations were successful, and no complications were found. MRI was done, and the result showed that the prolapsed nucleus pulposus was disappeared. The mean postoperative hospital stay and the mean period before returning to work in group B was significantly shorter than that in group A （P 〈 0. 001 ）. There was a significant decrease in VAS and a significant increase in JOA scores at all examinations postoperation （ P 〈 0.05 ）. Group B showed lower levels of VAS than group A and higher levels of JOA scores than group A at 1 d, 1 week, 1 month of follow-up examination （ P 〈 0. 001 ）. There was no significant difference in VAS and JOA scores in the two groups at 6 months of follow-up examination （ P 〉 0. 05 ）. According to the modified MacNab criteria at 6 months of follow-up, excellent, good and fair outcomes were 38,17 and 2 in group A, and which in group B were 36,19 and 2, the excellent-good rate of two groups were both 96% , there was no significant difference in the two groups （ P 〉 0. 05 ）. Conclusions PEID is an mini-invasive technique for PLDH, it can significantly reduce pain and improve function. Combination of epidural in- jection has the advantages of better pain reducing and function improving in the short-term postoperative period, and it is a safe and effective method.