保留黄韧带治疗腰椎间盘突出症的疗效观察

Observation on the efficacy of preserving ligamentum flavum in the treatment of lumbar disc herniation

目的:观察椎间孔镜下治疗腰椎间盘突出症保留黄韧带的临床疗效及对腰椎曲线指数(LCI)和椎间隙高度的影响。方法:收集2015年6月至2018年12月广西贺州市人民医院收治的120例腰椎间盘突出症患者,按随机数字表法分为观察组与对照组,每组各60例。对照组患者椎间孔镜术中切除部分黄韧带;观察组保留黄韧带。比较两组患者术后1周、6个月及1年的疼痛视觉模拟量表(VAS)评分、腰椎Oswestry功能障碍指数(ODI)、LCI及椎间隙高度。比较两组术后1年的疗效。结果:观察组手术时间短于对照组,术后并发症发生率低于对照组(P<0.05)。两组术后ODI、VAS评分及椎间隙高度均呈下降趋势,且观察组下降幅度高于对照组(均P<0.001),对照组术后各时间点的VAS评分及ODI均高于观察组(均P<0.05)。两组术后LCI均呈升高趋势,对照组升高幅度高于观察组(P<0.001),对照组术后各时间点LCI均高于观察组(均P<0.05)。术后1年,观察组优良率高于对照组(P<0.001)。结论:椎间孔镜下治疗腰椎间盘突出症保留黄韧带术后临床疗效、LCI及椎间隙高度优于切除部分黄韧带。

Objective:To observe the clinical efficacy of preserving ligamentum flavum in the treatment of lumbar disc herniation under TESSYS and its effect on lumbar curve index(LCI)and intervertebral space height.Methods:A total of 120 patients with lumbar disc herniation treated in ourhospital from June 2015 to December 2018 were randomly divided into observation group and control group,with 60 cases in each group.Partial resection of ligamentum flavum was performed in the control group,while ligamentum flavum was preserved in the observation group.The visual analogue scale(VAS)score,lumbar Oswestry dysfunction index(ODI),LCI and intervertebral space height were compared between the two groups at 1 week,6 months and 1 year after operation.The efficacy of the two groups was compared one year after operation.Results:The operation time in the observation group was shorter than that in the control group,and the incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).The scores of ODI,VAS and the height of intervertebral space decreased in both groups,and the decrease in the observation group was higher than that in the control group(P<0.001).The VAS score and ODI in the control group were higher than those in the observation group at each time point after operation(P<0.05).LCI increased after operation in both groups,the LCI of the control group was higher than that of the observation group(P<0.001).The LCI of the control group was higher than that of the observation group at each time point after operation(P<0.05).One year after operation,the excellent rate in the observation group was higher than that in the control group(P<0.001).Conclusion:The clinical efficacy,LCI and height of intervertebral space after preservation of ligamentum flavum in treating lumbar disc herniation under TESSYS were better than that of resection of ligamentum flav.