经皮椎间孔镜下髓核摘除术对腰椎间盘突出症患者术后康复及JOA评分的影响

Effect of Percutaneous Transforaminal Nucleus Pulposus Removal on Postoperative Rehabilitation and JOA Score in Patients with Lumbar Disc Herniation

目的分析经皮椎间孔镜下髓核摘除术对腰椎间盘突出症(LDH)患者术后康复及日本骨科协会评估治疗分数评分(JOA)的影响。方法选取2016年4月-2018年4月该院收治的88例LDH患者,简单随机化分组,对照组(n=44)给予微创椎板间开窗髓核摘除术,观察组(n=44)给予经皮椎间孔镜下髓核摘除术,比较两组手术一般情况(手术时间、术中出血量、手术切口长度、术后下床活动时间、住院时间)、JOA评分、并发症发生率。结果观察组术中出血量、手术切口长度、术后下床活动时间、术后住院时间分别为(60.45±7.94)m L、(0.50±0.11)cm、(1.11±0.53)d、(5.87±1.26)d,均低于对照组的(79.19±8.55)mL、(3.11±0.16)cm、(2.59±0.61)d、(9.66±1.35)d,差异有统计学意义(t1=10.654,P1=0.000;t2=89.165,P2=0.000;t3=12.149,P3=0.000;t4=13.614,P4=0.000)。观察组术后3个月、6个月JOA评分分别为(23.05±0.42)分、(27.54±0.16)分,高于对照组的(19.77±0.35)分、(24.07±0.14)分,差异有统计学意义(t1=39.796,P1=0.000;t2=108.265,P2=0.000);观察组并发症发生率(2.27%,1/44)与对照组(4.55%,2/44)比较差异无统计学意义(χ^2=0.000,P=1.000)。结论经皮椎间孔镜下髓核摘除术应用于LDH患者,创伤较小,能减少术中出血量,缩短手术时间,促进患者恢复,改善患者腰部功能。

Objective To analyze the effect of percutaneous transforaminal nucleus pulposus removal on postoperative rehabilitation of lumbar disc herniation(LDH)patients and the evaluation of treatment score(JOA)by the Japanese Orthopaedic Association.Methods Eighty-eight patients with LDH admitted to the hospital from April 2016 to April2018 were enrolled in this study.The patients in the control group(n=44)were treated with minimally invasive interlaminar nucleus pulposus removal.The observation group(n=44)with percutaneous transforaminal nucleus pulposus,and the general conditions of the operation(surgery time,intraoperative blood loss,length of surgical incision,time of postoperative ambulation,hospital stay,JOA score,and complications were compared.Results The intraoperative blood loss,length of surgical incision,time of postoperative ambulation,and postoperative hospital stay were(60.45±7.94)m L,(0.50±0.11)cm,(1.11±0.53)d,(5.87±1.26)d,both lower than(79.19±8.55)mL,(3.11±0.16)cm,(2.59±0.61)d,(9.66±1.35)d,the difference was statistically significant(t1=10.654,P1=0.000;t2=89.165,P2=0.000;t3=12.149,P3=0.000;t4=13.614,P4=0.000).The JOA scores of the observation group at 3 months and 6 months were(23.05±0.42)points and(27.54±0.16)points,which were higher than those of the control group(19.77±0.35)points and(24.07±0.14)points,the difference was statistically significant(t1=39.796,P1=0.000;t2=108.265,P2=0.000);the incidence of complications in the observation group(2.27%,1/44)was not significantly different from that in the control group(4.55%,2/44)(χ^2=0.000,P=1.000).Conclusion Percutaneous transforaminal nucleus pulposus is applied to patients with LDH with less trauma,which can reduce the amount of intraoperative blood loss,shorten the operation time,promote the recovery of patients and improve the waist function of patients.