椎间孔镜髓核摘除术配合主动腰背肌锻炼治疗腰椎间盘突出症

Percutaneous transforaminal endoscopic discectomy combined with active back muscle exercise for treatment of lumbar disc herniation

[目的]评价经皮椎间孔镜髓核摘除术配合早期规律腰背肌功能锻炼治疗腰椎间盘突出症(LDH)的临床疗效。[方法]2016年7月~2017年9月腰椎间盘突出症患者100例,按随机数字表将其分为锻炼组和常规组,每组50例。两组患者均行椎间孔镜髓核摘除术,锻炼组术后第2d由医生指导其在床上进行规律的腰背肌功能锻炼。而常规组患者术后卧床休息、常规恢复活动。采用疼痛视觉模拟评分(VAS评分)、Oswestry功能障碍指数(ODI)评分及日本骨科协会(JOA评分)腰椎评分评价临床效果。[结果]两组患者均顺利完成手术,术后随访≥1年。随时间延长,两组患者ODI评分均显著减少,JOA评分均显著增加;而锻炼组患者VAS评分随时间延长显著减少,但常规组患者术后1年与术后3个月相比,VAS评分不减反增,不同时间点间差异均有统计学意义(P<0.05)。术前、术后1d和术后3个月,两组间VAS评分差异无统计学意义(P>0.05);但术后1年,锻炼组的VAS评分显著低于常规组,差异有统计学意义(P<0.05)。术前和术后1d,两组间ODI和JOA评分差异无统计学意义(P>0.05);但术后3个月和术后1年,锻炼组上述评分显著优于常规组,差异有统计学意义(P<0.05)。[结论]采用经皮椎间孔镜术配合早期主动规律的腰背肌功能锻炼可显著改善腰椎盘突出症的治疗效果。

[Objective]To evaluate the clinical outcomes of percutaneous transforaminal endoscopic discectomy combined with early active muscle exercise for lumbar disc herniation(LDH).[Methods]A total of 100 patients who suffered from lumbar disc herniation from July 2016 to September 2017 were included into this study and divided equally into the exercising group and the conventional group by random number table method with 50 patients in each group.All the patients received percutaneous transforaminal endoscopic discectomy.After that,the patients in the exercising group took regular active back muscle exercises beginning from the second day after operation,while those in the conventional group had bed rest and routine recovery of motion capacity.The visual analogue scale(VAS)for pain,Oswestry disorder index(ODI)and Japanese Orthopaedic Association(JOA)lumbar score were used for evaluation of the clinical consequences.[Results]All the patients had surgical operation performed smoothly,and then were followed up for more than 1 year.The VAS score of the exercise group and the ODI score of both groups significantly decreased and the JOA scores of both groups were significantly increased as time went on,which proved statistically significant(P<0.05).Although no statistically significant differences were found in VAS scores between the two group before operation,at 1 day and 3 months postoperatively(P>0.05),the exercising group took significantly lower VAS score than the conventional group at 1 year postoperatively(P<0.05).In addition,the exercising group proved significantly superior to the conventional group regarding to the ODI and JOA scores at 3 months and 1 year postoperatively(P<0.05),despite of the facts that no statistically significant differences were noticed between the two groups in ODI and JOA scores before operation and at 1 day postoperatively(P>0.05).[Conclusion]The percutaneous transforaminal endoscopic discectomy combined with early active muscle exercise does considerably improve the clinical outcomes for lumbar disc herniation.