经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症疗效比较

Application value of percutaneous foraminoscopy versus laminotomy in the treatment of lumbar disc herniation

目的比较经皮椎间孔镜与单纯椎板开窗术治疗腰椎间盘突出症的临床疗效。方法选择西安市第四医院骨科于2018年1月至2018年12期间收治的96例腰椎间盘突出症患者为研究对象,根据随机数表法将患者分为观察组与对照组,每组48例,分别接受经皮椎间孔镜与单纯椎板开窗术治疗。比较两组患者的手术时间、术中出血量、切口长度、卧床时间,术前及术后6个月采用疼痛视觉模拟法(VAS)进行疼痛评分,采用Oswesttry功能障碍指数(ODI)进行功能评价,采用改良MacNab标准评价疗效。结果观察组患者的手术时间、术中出血量、切口长度、卧床时间分别为(60.20±14.28) min、(11.40±3.45) mL、(0.89±0.28) cm、(9.42±3.28) h,均明显少于或短于对照组的(78.49±20.39) min、(68.39±27.29) mL、(3.52±1.06) cm、(22.41±6.59) h,差异均有统计学意义(P<0.05);术后6个月,观察组与对照组患者VAS评分及ODI评分分别为(1.29±0.44)分、(9.40±2.68)分和(1.45±0.65)分、(10.02±3.01)分,均较术前的(6.42±2.09)分、(32.10±5.29)分和(6.27±1.97)分、(33.42±6.72)分明显降低,差异均有统计学意义(P<0.05);但是观察组与对照组术后6个月的VAS评分及ODI评分比较差异均无统计学意义(P>0.05);观察组患者的治疗优良率为83.33%,与对照组的87.50%比较差异无统计学意义(P>0.05)。结论经皮椎间孔镜与单纯椎板开窗术均是治疗腰椎间盘突出症的有效方法,但是前者具有手术切口小、术中出血量少等优势,更值得临床推广应用。

Objective To compare the efficacy of percutaneous foraminoscopy versus laminotomy in the treatment of lumbar disc herniation.Methods Ninety-six patients with lumbar intervertebral disc herniation treated in Department of Orthopaedics,Fourth Hospital of Xi'an from January 2018 to December 2018 were selected as the research objects.According to the random number table,the patients were randomly divided into observation group and control group,with 48 patients in each group,which were treated with percutaneous foraminoscopy and simple laminotomy,respectively.The perioperative clinical indexes of the two groups were compared,including operation time,intraoperative bleeding volume,incision length,and bed rest time.Visual Analogue Scale(VAS)was used to assess pain before and 6 months after operation.Oswestry dysfunction index(ODI)was used to evaluate function,and improved MacNab standard was applied to evaluate the efficacy.Results The operation time,intraoperative bleeding volume,incision length,and bed rest time of the observation group were(60.20±14.28)min,(11.40±3.45)mL,(0.89±0.28)cm,(9.42±3.28)h,respectively,which were significantly less than(78.49±20.39)min,(68.39±27.29)mL,(3.52±1.06)cm,(22.41±6.59)h in the control group(P<0.05).Six months after operation,the VAS score and ODI score were(1.29±0.44)points,(9.40±2.68)points in the observation group and(1.45±0.65)points,(10.02±3.01)points in the control group,which were significantly lower than(6.42±2.09)points,(32.10±5.29)points and(6.27±1.97)points,(33.42±6.72)points before operation(P<0.05),but there was no significant difference in VAS score and ODI score between the two groups 6 months after operation(P>0.05).The treatment excellent and good rate of the observation group was 83.33%,which was similar with 87.50%the control group(P>0.05).Conclusion Percutaneous foraminoscopy and laminotomy are both effective methods for the treatment of lumbar disc herniation,but the former has the advantages of minimally invasive such as small incision and less bleeding during operation,and is more worthy of clinical application.