经皮低温消融髓核成形术治疗椎间盘源性腰痛的临床研究

Clinical study of percutaneous coablation nucleoplasty for the treatment of discogenic low back pain

目的评价经皮低温消融髓核成形术(PCNP)治疗椎间盘源性腰痛(DLBP)的临床效果。方法回顾性分析2015年3月-2019年3月北京市垂杨柳医院骨科收治的行PCNP的97例单节段DLBP患者的临床病例资料,分为PCNP组(接受PCNP手术治疗,n=43)和对照组(保守治疗,n=54)。记录两组患者的性别构成、年龄、病程、住院时间、随访时间、手术时间、责任节段、Pfirrmann分级及手术并发症。术后1个月、3个月、6个月常规门诊复查随访6~36个月,术前、术后1个月、3个月及6个月采用数字评定法(NRS)评分及Roland-Morris功能障碍调查表(RMDQ)评分评价治疗效果。正态分布的计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验,治疗前后NRS评分及RMDQ评分比较采用重复测量数据方差分析。计数资料以例(%)表示,组间比较采用χ2检验或者Fisher精确检验;随访时间及等级分组资料组间比较采用Mann-Whitney秩和检验。应用统计学软件SPSS 20.0处理数据,P<0.05为差异有统计学意义。结果PCNP患者平均手术时间为(36.3±13.2)min(15~65 min),没有发生手术并发症。两组患者治疗后NRS评分、RMDQ评分均显著下降(F组内=26.000,P=0.001;F组内=26.000,P0.001),PCNP组NRS评分、RMDQ评分下降更明显(F组间=5.666,P=0.024;F组间=4.261,P=0.048),而且PCNP组NRS评分、RMDQ评分随着时间的下降趋势也更明显(F交互=26.000,P=0.028;F交互=26.000,P=0.010)。结论PCNP治疗DLBP在疼痛缓解和改善功能障碍方面取得了良好的临床效果。PCNP是一种安全、微创、有效的治疗方法,治疗效果维持时间长,明显优于保守治疗。

Objective To evaluate the clinical effect of percutaneous coablation nucleoplasty(PCNP)in the treatment of discogenic low back pain(DLBP).Methods From March 2015 to March 2019,the clinical data of 97 single segment DLBP patients with PCNP admitted to orthopaedic department of Beijing Chui Yang Liu hospital were analyzed retrospectively.They were divided into PCNP group(n=43)and control group(n=54).The sex proportion,age,medical history,length of hospital stay,follow-up time,operation time,responsibility segment,Pfirrmann classification and complications were recorded.1 month,3 months and 6 months after the operation,the routine outpatient reexamination and follow-up were conducted for 6-36 months.The therapeutic effect was evaluated by numeric rating scale(NRS)and Roland-Morris Disability Questionnaire(RMDQ)before,1 month,3 months and 6 months after the operation.Measurement data were presented by Mean±SD,t test was used for comparison between groups,and analysis of variance of repeated measurement data was used for comparison of NRS score and RMDQ score before and after treatment.The counting data were expressed by percentage,χ2 test or Fisher precision test was used for comparison between groups,and Mann-Whitney rank sum test was used for comparison between groups of follow-up time and hierarchical grouping data.Statistical software SPSS 20.0 was used to process the data,P<0.05 was statistically significant.Results The average operation time of PCNP patients was(36.3±13.2)min(15 to 65 min),and no complications occurred.After treatment,the NRS score and RMDQ score of the two groups decreased significantly(F组内=26.000,P=0.001;F组内=26.000,P=0.001),and the NRS score and RMDQ score of the PCNP group decreased more significantly(F组间=5.666,P=0.024;F组间=4.261,P=0.048),and the NRS score and RMDQ score of the PCNP group decreased more significantly with time(F交互=26.000,P=0.028;F交互=26.000,P=0.010).Conclusion PCNP with DLBP patients showed satisfied clinical results in pain relief and improve dysfunction.PCNP is a safe,minimally invasive and effective treatment method,which has a long therapeutic effect and is superior to conservative treatment.