腰椎后路镜下微创手术对腰椎间盘突出症患者疼痛及腰椎稳定性的影响

Effects of lumbar posterior microscopically minimally invasive surgery on the pain and lumbar stability in patients with lumbar intervertebral disc protrusion

目的探讨腰椎后路镜下微创手术对腰椎间盘突出症患者疼痛及腰椎稳定性的影响。方法选取确诊治疗的腰椎间盘突出症患者140例,依据随机数表法随机分为微创组和传统组,每组70例。微创组患者给予腰椎后路镜下微创手术治疗,传统组患者给予传统开放椎板间开窗髓核摘除术治疗,采用日本骨科协会(JOA)腰椎评分法评估治疗疗效,采用视觉模拟评分法(VAS)评估疼痛程度,随访6个月,分析患者手术时间、术中出血量、住院时间、恢复工作时间、返岗情况和治疗前后腰椎稳定性(腰椎Cobb角、腰椎曲度指数、椎间水平位移和角位移)、治疗后3、6个月的治疗疗效、治疗前、治疗后1、3、6个月的疼痛程度及并发症情况。结果微创组患者手术时间、术中出血量、住院时间、恢复工作时间明显低于传统组,差异有统计学意义(P<0.05),但2组患者返岗率差异无统计学意义(P>0.05);微创组患者治疗后腰椎Cobb角、椎间水平位移和角位移明显低于传统组,腰椎曲度指数明显高于传统组,差异有统计学意义(P<0.05);2组患者治疗后3个月优良率和JOA得分差异无统计学意义(P>0.05),但微创组治疗后6个月优良率和JOA得分明显高于传统组,差异有统计学意义(P<0.05);微创组患者治疗后1、3、6个月VAS得分明显低于传统组,差异有统计学意义(P<0.05);微创组患者并发症发生率明显低于传统组,差异有统计学意义(P<0.05)。结论腰椎后路镜下微创手术治疗可有效减少腰椎间盘突出症患者术中创伤和促进患者术后恢复,可有效维持患者的腰椎稳定性,对患者返岗和近期疗效无明显提升作用,但有利于患者早日恢复工作、缓解其疼痛症状和提高其远期疗效,且具有更为良好的安全性,值得临床作进一步推广。

Objective To investigate the effects of lumbar posterior microscopically minimally invasive surgery on the pain and lumbar stability in patients with lumbar intervertebral disc protrusion. Methods A total of 140 patients with lumbar intervertebral disc protrusion who were treated in our hospital were enrolled in the study. According to random number table,these patients were divided into the minimally invasive group and traditional surgery group,with 70 patients in each group. The patients in minimally invasive group were treated by lumbar posterior microscopically minimally invasive surgery,however,the patients in traditional surgery group were treated by nucleus pulposus excision via open window between lamina of vertebra. The therapeutic effects were evaluated by means of Japanese orthopaedic association（ JOA） lumbar score,and patient ＇s pain degree was assessed by visual analogue scale（ VAS）,moreover,all the patients were followed up for 6 months,then the operation duration,intraoperative hemorrhage volume,length of staying in hospital,recovery work time,time of returning to work,lumbar spinal stability before and after treatment（ lumbar Cobb angle,lumbar curvature index,intervertebral level displacement and angular displacement）,the therapeutic effects on 3,6 months after treatment,pain degree before treatment and on 1,3,6 months after treatment,the incidence rates of complications were observed and compared between two groups.Results The operation duration,intraoperative hemorrhage volume,length of staying in hospital,recovery work time in minimally invasive group were significantly lower than those in traditional surgery group（ P〈0. 05）,however,there were no significant differences in return to original position rates between two groups（ P〈0. 05）. The lumbar Cobb angle,intervertebral level displacement and angular displacement in minimally invasive group were significantly lower than those in traditional surgery group,and the lumbar curvature indexes in the former were significantly higher than those in the latter（ P〈0. 05）. There were no significant differences in the excellence rates on 3 months after treatment and JOA scores between minimally invasive group and traditional surgery group（ P〈0. 05）,however,the excellence rates on 6 months after treatment and JOA scores in the former were significantly higher than those in the latter（ P〈0. 05）. The VAS scores on 1,3,6 months after treatment in minimally invasive group were significantly lower than those in traditional surgery group（ P〈0. 05）. The incidence rates of complication in minimally invasive group were significantly lower than those in traditional surgery group（ P〈0. 05）.Conclusion The lumbar posterior microscopically minimally invasive surgery can effectively decrease the intraoperative trauma of patients with lumbar disc prolapse and can promote postoperative recovery,which can effectively maintain the stability of lumbar spine,however,which has no obvious effects on return to original position rate of patients and on short-term curative effects,but which can alleviate the symptoms of pain and can effectively improve long-term curative effects,with better safety,therefor,which is worth using widely in clinical practice.