硬膜外注射辅助椎间孔镜技术治疗脱出型腰椎间盘突出症的疗效观察

Clinical observation of prolapsed lumbar disc herniation treated by epidural injection with intervertebral foramen endoscope

目的探讨硬膜外注射辅助椎间孔镜技术治疗脱出型腰椎间盘突出症(prolapsed lumbar disc herniation,PLDH)的临床疗效。方法回顾性分析2014-07-2015-07采用椎间孔镜技术治疗的160例PLDH患者,其中74例于术中联用硬膜外注射药物进行治疗(药物配方为:2 ml甲钴胺+1 ml复方倍他米松注射液+1 ml利多卡因),将其作为联合组;另86例单纯予以经皮椎间孔镜技术治疗,作为对照组。对两组患者术后的相关指标进行对比。结果:联合组术后住院时间、恢复工作时间均显著短于对照组,差异有统计学意义(P<0.05)。两组患者术后随访19-32个月,平均24个月。组间对比,联合组在术后1 d、7 d、1月时,其VAS评分显著低于对照组,JOA评分显著高于对照组(均为P<0.05);但末次随访时,两项指标在组间无显著性差异(P>0.05)。在末次随访时,联合组优良率为94.6%,与对照组的93.0%对比,差异无统计学意义(x^2=0.220;P>0.05)。结论:在经皮椎间孔镜技术联合硬膜外注射药物,可显著提高PLDH术后早期的疼痛和功能改善效果,有利于患者早日出院、早日恢复工作,有一定的临床应用价值。

Objective To investigate the clinical efficacy of epidural injection assisted transforaminal disceetomy in the treatment of prolapsed lumbar disc herniation（PLDH）. Methods From July 2014 to July 2015, the clinical data of 160 PLDH patients who were treated by the mirror intervertebral foramen were retrospectively analyzed. 74 cases in the combined group received epidural injection of drugs during operation （drug formulation was：2 ml mecobalamin ＋1 ml compound betamethasone injection ＋1 ml lidocaine）. Another 86 patients in the control group were treated with percutaneous transforaminal endoscopic technique. The relative indicators of the two groups were compared. Results The postoperative hospitalization time and the recovery time of the combined group were significantly shorter than those of the control group, the differences were statistically significant （P〈0.05）. The two groups were followed up for 19-32 months, with an average of 24 months. 1 day, 7 days, 1 month after operation, the VAS scores of the combined group were significantly lower than those of the control group, JOA score was significantly higher than the control group （P〈0.05）; but at the end of the follow-up, there were no significant differences in VAS and JOA score between the two groups （P〉0.05）. At the last follow-up, the excellent and good rate of the combined group was 94.6%, that of the control group was 93%, the difference was not statistically significant （x^2=0.220; P〉 0.05）. Conclusion Percutaneous transforaminal endoscopic surgery combined with epidural injection of drugs in the treatment of PLDH can significantly improve the postoperative pain and improve the function of the early effect, it is beneficial to patients with early discharge and recovery work, has certain clinical application value.