髓核摘除结合Dynesys动态稳定和单纯髓核摘除治疗腰椎间盘突出症的临床疗效及对患者VAS评分、ODI评分及并发症的影响

The clinical efficacy of discectomy combined with Dynesys dynamic stabilization and simple discectomy in the treatment of lumbar disc herniation and its influence on VAS score,ODI score,and complications

目的分析髓核摘除结合Dynesys动态稳定与单纯髓核摘除术治疗腰椎间盘突出症的临床价值。方法我院收治的93例腰椎间盘突出症患者,按治疗方式分为常规组(单纯髓核摘除术,n=40)与联合组(髓核摘除联合Dynesys动态固定,n=53),比较两组手术情况、治疗效果、手术前后视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评分的变化,记录手术前后不同时间手术节段、相邻节段椎间隙高度、活动度的变化,统计手术并发症发生情况。结果联合组手术时间长于常规组,术中出血量、髓核摘除量多于常规组,开窗面积大于常规组,术后下床活动时间及住院时间短于常规组(P<0. 05)。术后不同时间两组VAS评分、ODI评分均降低,联合组低于常规组(P<0. 05)。末次随访,联合组手术节段椎间隙高度、相邻节段椎间隙高度较术前无明显变化,但高于常规组;联合组手术节段活动度减少,但低于常规组(P<0. 05)。两组总治疗有效率、并发症发生率比较,差异无统计学意义(P>0. 05)。结论髓核摘除联合Dynesys动态稳定系统治疗腰椎间盘突出症整体价值优于单纯髓核摘除术,可减轻患者术后疼痛感,改善腰椎功能,且稳定性好,并发症少,可避免术后椎间隙高度丢失。

Objective To analyze the clinical value of discectomy combined with Dynesys dynamic stabilization and simple discectomy in the treatment of lumbar disc herniation.Methods Ninety-three patients with lumbar disc herniation in our hospital were divided into conventional group (single discectomy,n = 40) and combined group (discectomy combined with Dynesys dynamic fixation,n = 53) according to the treatment methods. The operation status,treatment effects,and changes of scores of Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) before and after operation were compared between the two groups.The changes in the height and activity of intervertebral space in operative segment and adjacent segments were recorded at different time points before and after operation.The occurrence of surgical complications was counted.Results The operative time was longer,the intraoperative blood loss was more,the nucleus pulposus removal amount was higher,the window opening area was larger,the postoperative ambulation time and the hospital stay were shorter in the observation group than those in the conventional group (P< 0. 05). The VAS score and ODI score in the two groups were decreased at different time points after operation( P<0. 05),and the scores of VAS and ODI in the combined group were lower than those in the conventional group at different time points after operation (P< 0. 05). At the last follow-up,there were no significant changes in the intervertebral space height of operative segments and intervertebral space height of adjacent segments in the combined group when compared with those before operation,but they were higher than those in the conventional group (P<0. 05).The range of motion of operative segments was decreased in the combined group and was lower than that in the conventional group (P<0. 05).The total effective rate of treatment and the incidence rate of complications in the combined group was slightly lower than that in the conventional group but not reach statistically significant (P>0. 05).Conclusion Discectomy combined with Dynesys dynamic stabilization system has better overall effect than simple discectomy in the treatment of lumbar disc herniation.The therapy can reduce the postoperative pain and improve the lumbar function.It has good stability and few complications.In addition,it can avoid the loss of postoperative intervertebral space height.