PELAN治疗DLBP的疗效评价及影响预后的可变因素研究

Study on the therapeutic effects and variable prognostic factors of percutaneous endoscopic lumbar annuloplasty and nucleoplasty in treatment of discogenic low back pain

目的评价经皮内镜下腰椎纤维环髓核成形术治疗间盘源性腰痛的效果并探讨影响其预后的可变因素。方法选择89例手术患者为研究对象。术后行短期(3~4周)及长期(至少12个月)随访。临床疗效采用数字疼痛评分法(NRS)、Oswestry功能障碍指数%(ODI%)和改良的Macnab标准进行评价。将NRS评分减少≥50%、ODI%下降≥40%和Macnab标准评定为良或优的患者视为治疗成功组,其余患者视为治疗失败组。比较探讨2组间影响预后的临床表现及影像学可变因素。结果术后短期和长期随访疗效结果比较,NRS评分明显减少的患者数分别为62例(69.7%)和68例(76.4%),ODI%明显降低的患者数分别为59例(66.3%)和68例(76.4%),Macnab评定为良或优的患者比例分别为61%和65.2%。弯腰疼痛与预后结果良好明显相关,Modic分型改变与预后结果较差明显相关。结论经皮内镜下腰椎纤维环髓核成形术治疗间盘源性腰痛的疗效满意,弯腰疼痛是预后疗效良好的可变因素,Modic分型改变预后疗效较差的可变因素。

Objective To evaluate the therapeutic effects of percutaneous endoscopic lumbar annuloplasty and nucleoplasty(PELAN)in treatment of discogenic low back pain(DLBP),and to explore the variable factors affecting prognosis of patients.Methods A total of 89 patients with DLBP who underwent PELAN were selected as the subjects.After surgery,these patients were followed up for short-term period(3~4 weeks)and long-term period(at least 12 months).The Numeric Rating Scale(NRS),Oswestry Dysfunction Index%(ODI%),and modified Macnab criteria were used to evaluate the clinical efficacy.The patients were defined as treatment successful group if the NRS scores were decreased more than 50%and ODI%was decreased more than 40%,as well as the Macnab evaluation was good or excellent,however the other patients were regarded as treatment failure group.The clinical features influencing prognosis of patients and iconography variable factors were observed and compared between the two groups.Results The curative effect comparison of short-term follow-up and long-term follow-up showed that the patients with obvious decrease of NRS scores were 62 cases(69.7%)and 68 cases(76.4%),respectively,and the patients with obxious decrease of ODI%were 59 cases(66.3%)and 68 cases(76.4%),respectively,and the proportion of patients with good or excellent of Macnab evaluation was 61%and 65.2%,respectively.The pain during waist flexion was significantly related with the fall out well of prognasis,and the changes of Modic somatotype were closely correlated with the poor outcome of prognasis.Conclusion The curative effects of PELAN in treatment of DLBP are satisfactory.The pain during waist flexion is the variable factors for the better therapeutic effects and good prognosis,and the changes of Modic somatotype are the variable factors for the poor outcomes of prognosis.