经皮椎间孔镜技术配合康复训练治疗腰椎间盘突出症及对患者疼痛、焦虑和生活质量的影响

Clinical effect of percutaneous lumbar discectomy combined with rehabilitation training in the treatment of lumbar disc herniation and its influence on pain, anxiety and quality of life

目的探讨经皮椎间孔镜腰椎髓核摘除术(PTED)配合康复训练治疗腰椎间盘突出症(LDH)的临床研究及对患者疼痛、焦虑和生活质量的影响。方法选取2014-07-2016-07本院收治的LDH患者150例,随机分为对照组(n=75)及实验组(n=75),2组均行PTED手术治疗,对照组给予术后常规处理,实验组给予围手术期至术后6个月个性化综合康复训练。结果治疗后实腰椎间盘突出症(lumbar disc herniation,LDH)常由椎间盘变性引起纤维环受损/髓核突出,压迫刺激脊神经根所致,是腰腿痛的常见病因,也是脊柱脊髓神经外科的常见多发病[1-2]。本病病程长、反复发作,若治疗不及时或治疗不当会严重影响患者生活[3]。内科保守疗法治疗易复发,效果不理想,10%~验组总有效率(96.00%)明显高于对照组(74.67%)。与术前比较,术后1 d 2组VAS、SAS评分升高,术后1~6个月2组VAS、SAS评分降低,且实验组显著低于对照组(P<0.05或P<0.01)。与术前比较,术后2组ODI均明显降低,且实验组显著低于对照组(P<0.01);而2组腰椎功能评分均明显升高,且实验组显著高于对照组(P<0.01)。术后3个月2组SF-36各项评分均较术前有不同程度的升高(P<0.05或P<0.01),且实验组显著高于对照组(P<0.01)。术后实验组GMP-140、PLT较术及对照组前显著降低(P<0.05或P<0.01)。结论 PTED联合围手术期及术后康复治疗LDH疗效显著,可明显降低患者术后疼痛感、缓解焦虑心情,显著改善患者腰椎局部微循环,促进腰椎功能恢复,降低血小板活化,提高患者术后生活质量,值得临床上推广应用。

Objective To investigate the clinical effects of percutaneous lumbar disc nucleus pulposus(PTED)combined with rehabilitation training in the treatment of lumbar disc herniation(LDH),and its influence on pain,anxiety and quality of life.Methods From July 2014 to July 2016,150 patients with LDH in our hospital were randomly divided into control group(n=75)and experimental group(n=75).The two groups were treated with PTED,the patients in control group were given routine postoperative treatment,and the patients in experimental group were given individualized comprehensive rehabilitation training from the perioperative period to postoperative 6 months.The clinical curative effect of two groups was statistically analyzed.Results The total effective rate in the experimental group(96.00%)was significantly higher than that in the control group(74.67%).Compared with preoperation,visual analog scale(VAS)and self-rating anxiety scale(SAS)scores at postoperative 1 d was increased in two groups.The VAS and SAS scores of two groups were decreased at postoperative 1-6 months,and those in the experimental group were significantly lower than control group(P<0.05 or P<0.01).The osweatry dysfunction index(ODI)of two groups was significantly decreased compared with before operation,and the ODI in the experimental group was significantly lower than that in control group(P<0.01).The lumbar function score in two groups was significantly increased,and the score of the experimental group was significantly higher than that of the control group(P<0.01).After 3 months,the scores of SF-36 in two groups were higher than preoperation(P<0.05 or P<0.01),and SF-36 score of the experimental group was significantly higher than that of the control group(P<0.01).After operation,the levels of plateletα-granule membrane protein 140(GMP-140)and platelet count(PLT)in the experimental group were significantly lower than those in the control group(P<0.05 or P<0.01).Conclusion PTED combined with perioperative period and postoperative rehabilitation therapy in the treatment of LDH has significant effect,can significantly reduce postoperative pain,relieve anxiety,improve the local lumbar microcirculation of patients,promote functional recovery,reduce platelet activation,improve the quality of life of patients,it is worthy of clinical application.