采用椎间孔镜治疗双节段腰椎间盘突出症的临床效果观察

Clinical efficacy of intervertebrai foraminoscopy in the treatment of double segmental protrusion of lumbar intervertebral disc

目的分析椎间孔镜治疗双节段腰椎间盘突出症疗效及安全性。方法选择2016年2月至2017年5月间日照市中心医院诊治的126例双节段腰椎间盘突出患者，根据治疗方法的不同分为观察组和对照组，各63例。观察组采用椎间孔镜技术，对照组采用常规开窗手术，比较两组治疗情况，并比较两组手术前后疼痛视觉模拟评分法（VAs）评分、OsWestry功能障碍指数（0DI）的差异。结果与对照组比较，观察组住院时间短[（7．1±3．1）d比（11．5±4．2）d]，切口长度小[（1．2±0．3）cm比（4．3±1．6）cm]，术中出血量少[（22．3±8．2）mL比（36．3±9．2）mL]，两组比较差异均有统计学意义（t=9．365、3．965、5．566，均P〈0．05）。术前至术后6个月，两组VAS评分均呈明显下降趋势，两组VAS评分在组间、不同时间点、组间不同时点间交互作用差异均有统计学意义（F=5．688、4．589、3．998，均P〈0．05）。术前至术后6个月，两组ODI呈先下降后上升趋势，两组ODI在不同时点间差异有统计学意义（F=4．254，P〈0．05）。观察组疗效优良率为87．3％，与对照组的84．1％比较，差异无统计学意义（X2=0．259，P〉0．05）。两组不良反应发生率（6．4％比9．5％）比较，差异无统计学意义（X2=0．434，P〉o．05）。结论椎间孔镜治疗双节段腰椎间盘突出症疗效可靠，组织创伤小；疼痛症状轻。

Objective To analyze the efficacy and safety of intervertebral endoscopy in the treatment of double segmental protrusion of lumbar intervertebral, disc. Methods From February 2016 to May 2017,126 patients with double segment lumbar disc herniation diagnosed in Rizhao Central Hospital were divided into the observation group and the control group according to the different treatment methods, with 63 cases in each group. The observation group was treated with intervertebral foramen technique,and the control group was treated with conventional fenestration. The treatment efficacy of the two groups was compared. The differences of VAS score and ODI between the two groups before and after operation were compared. Results Compared with the control group, the observation group had shorter hospitalization time [ （7.1 ±3. 1 ） d vs. （ 11.5 ±4.2 ） d ], smaller incision length [ （ 1.2 ±0. 3 ） cm vs. （ 4.3 ±1.6） cm] ,less blood loss[ （ 22.3 ±8.2 ） mL vs. （ 36.3 ±9.2 ） mL], there were statistically significant differences between the two groups （ t = 9.365,3. 965,5. 566, all P 〈 0.05 ）. From preoperation to 6 months after operation, the VAS scores of the two groups showed a significant downward trend. There were statistically significant difference in the VAS scores between the two groups at different time points, between groups and at different time points （ F = 5. 688, 4. 589,3. 998, all P 〈 0.05 ）. From preoperation to 6 months after operation, the ODI of the two groups decreased first and then increased, and there was statistically significant difference between the two groups of ODI in different time points （ F =4. 254,P 〈 O. 05 ）. The good rate of curative effect in the observation group was 87.3%, which in the control group was 84. 1%, the difference was not statistically significant （ X2 = 0. 259, P 〉 0.05 ）. There was no statistically significant difference in the incidence rate of adverse reactions between the two groups （6.4% vs. 9.5 % ） （X2 = 0. 434, P 〉 0.05）. Conclusion The treatment of double segment lumbar intervertebral disc herniation with intervertebral foraminoscopy is reliable,with small tissue trauma and mild pain.