后路椎间盘镜联合低温射频治疗腰椎间盘突出症

Posterior approach of microendoscopic discectomy combined with low temperature radiofrequency for lumbar intervertebral disc herniation

目的 评价后路椎间盘镜联合低温射频治疗腰椎间盘突出症的短期疗效.方法 选择2015年3月至2016年3月于郑州人民医院治疗的62例单节段腰椎间盘突出症患者为研究对象,随机分成两组,每组31例.A组行常规显微内镜下椎间盘髓核摘除术（MED）;B组行常规MED手术后,应用低温射频刀对椎间盘内的残余髓核组织进行消融,对纤维环开口进行热凝皱缩成形.分别于术前、术后1周和术后12个月采用视觉模拟量表（VAS）及改良的MacNab标准进行疗效比较.结果 所有患者均未发生神经损伤等严重并发症.与术前比较,两组患者术后VAS评分降低,差异有统计学意义（P〈0.05）;术后1周,B组VAS评分低于A组[（3.15±0.61）分比（4.48±1.29）分,P〈0.05];术后1年,两组VAS评分比较差异未见统计学意义（P〉0.05）.根据改良的MacNab标准,两组优良率比较差异未见统计学意义（P〉0.05）.结论 与单纯MED手术比较,后路椎间盘镜联合低温射频治疗腰椎间盘突出症能提高术后短期疗效.

Objective To evaluate the short-term effect of posterior approach of microendoscopic discectomy （ MED ） combined with low temperature radiofrequency on lumbar intervertebral disc herniation .Methods Sixty-two patients with single segment lumbar disc herniation which were treated in Zhengzhou People＇s Hospital from March 2015 to March 2016 were randomly divided into two groups , with 31 cases in each group .Patients in group A were given routine MED operation;patients in group B underwent MED firstly , and then underwent low temperature radiofrequency and heat condensation to ablate residual nucleus pulposus tissue in intervertebral disc and form opening of the fiber ring .Visual analogue scale （ VAS） and modified MacNab standard were used to compare efficacy of the two groups before operation , 1 week and 12 months after operation .Results No serious complications such as nerve injury occurred in any patients .Compared with those indexes before operation , VAS scores in the two groups significantly decreased after operation （ P 〈0.05 ）; at 1 week after operation , there was a significant difference in VAS score between group A and group B （4.48 ±1.29 vs.3.15 ±0.61,P〈0.05 ）;but there was no significant difference between group A and group B in the VAS score one year after operation （ P〉0.05 ） .In addition , there was no statistically significant difference in the excellence rate between the two groups according to the modified MacNab standard （P〉0.05）.Conclusions The short-term effects are significantly improved by posterior approach of endoscope combined with low temperature radiofrequency compared with MED operation only for lumbar intervertebral disc herniation .