椎间孔镜髓核摘除术与微创臭氧治疗腰椎间盘突出合并椎管狭窄的疗效比较

Comparative study of percutaneous transforaminal endoscopic discectomy and minimally invasive ozone therapy in the treatment of lumbar disc herniation combined with lumbar canal stenosis

目的 比较椎间孔镜髓核摘除术与微创臭氧治疗腰椎间盘突出合并椎管狭窄的疗效.方法 回顾性分析2015年5月至2017年5月90例腰椎间盘突出合并椎管狭窄患者的临床资料,其中行微创臭氧治疗45例（对照组）,行椎间孔镜髓核摘除术治疗45例（观察组）.比较两组手术基本情况、疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、日本骨科协会（JOA）评分及疗效等.结果 观察组手术时间明显长于对照组[（81.93 ± 17.02）min比（42.41 ± 15.69） min],术后住院时间明显短于对照组[（1.27 ± 1.05）d比（4.29 ± 2.03）d],差异有统计学意义（t=-9.571和3.742,P〈0.01）.观察组术后1周和1个月VAS明显低于对照组[（4.29 ± 1.39）分比（5.91 ± 1.51）分和（2.53 ± 0.69）分比（3.25 ± 0.94）分],差异有统计学意义（P〈0.01或〈0.05）.观察组术后3个月 ODI 和 JOA 评分明显优于对照组[（13.24 ± 5.86）分比（27.83 ± 8.91）分和（24.24 ± 3.09）分比（20.95 ± 6.25）分],差异有统计学意义（P〈0.01）.观察组优良率明显高于对照组[86.67%（39/45）比68.89%（31/45）],差异有统计学意义（χ2=4.114,P〈0.05）.结论 椎间孔镜髓核摘除术相较于微创臭氧治疗对于腰椎间盘突出合并椎管狭窄疗效更为显著、术后住院时间短、疼痛缓解明显、术后腰椎功能恢复迅速.

Objective To compare the efficacy of percutaneous transforaminal endoscopic discectomy with minimally invasive ozone therapy in the treatment of lumbar disc herniation combined with lumbar canal stenosis. Methods The clinical data of 90 patients with lumbar disc herniation combined with lumbar canal stenosis from May 2015 to May 2017 were analyzed retrospectively. The patients were divided into 2 groups according to the method of operation, control group （45 patients received minimally invasive ozone therapy）, and observation group （45 patients received percutaneous transforaminal endoscopic discectomy）. The basic surgical conditions, visual analog score （VAS）, Oswestry dysfunction index （ODI）, Japanese Orthopedic Association （JOA） score and efficacy were compared between 2 groups.Results The operation time in observation group was significantly longer than that in control group：（81.93 ± 17.02）min vs.（42.41 ± 15.69）min,postoperative hospitalization time was significantly shorter than that in control group： （1.27 ± 1.05） d vs. （4.29 ± 2.03） d, and there were statistical differences（t=-9.571 and 3.742,P〈0.01）.The VAS 1 week and 1 month after operation in observation group was significantly lower than that in control group：（4.29 ± 1.39）scores vs.（5.91 ± 1.51） scores and（2.53 ± 0.69）scores vs.（3.25 ± 0.94）scores,and there was statistical difference（P〈0.01 or〈0.05）.The ODI and JOA score 3 months after operation in observation group were significantly better than those in control group： （13.24 ± 5.86） scores vs. （27.83 ± 8.91） scores and （24.24 ± 3.09） scores vs. （20.95 ± 6.25） scores, and there were statistical differences （P〈0.01）. The eligible rate in observation group was significantly higher than that in control group： 86.67%（39/45）vs.68.89%（31/45）,and there was statistical difference（χ2=4.114,P〈0.05）.Conclusions Percutaneous transforaminal endoscopic discectomy compared with minimally invasive ozone therapy for lumbar disc herniation combined with lumbar canal stenosis is more effective,with shorter postoperative length of stay,more obvious pain relief and more quick lumbar function recovery after operation.