经皮椎间盘切吸联合硬膜外神经松解术治疗腰椎间盘突出症的临床研究

ClinicalStudy of Percutaneous Discectomy Combined with Epidural Nerve Release in the Treatment for Lumbar Disc Herniation

目的:通过联合应用经皮椎间盘切吸和硬膜外神经松解术治疗非包容性腰椎间盘突出症,评价联合治疗的可行性、有效性及安全性。方法:2014年5月-2017年10月,119例非包容性腰椎间盘突出症患者中64例单纯行经皮椎间盘切吸术(切吸组),55例行经皮椎间盘切吸联合硬膜外神经松解术(联合组)。采用疼痛视觉模拟评分(visual analogue scale,VAS)及oswestry功能障碍指数(oswestry disability index.,0DI)评价手术疗效。结果:119例患者全部顺利完成手术,无手术相关严重并发症发生。全部患者获随访,随访时间11-18个月,平均(13±2.8)个月。术后1个月、3个月和6个月:联合治疗组相比单纯切吸组在VAS评分(2.73±1.33vs.4.16±1.17;2.51±1.24 vs.3.71±1.19;2.48±1.16 vs.3.96±1.37)及临床疗效评估(37.50%vs74.55%;45.31%vs76.36%;43.75%vs78.18%)均具有统计学差异(P<0.05)。结论:应用经皮椎间盘切吸联合硬膜外神经松解术两种微创介入技术序贯治疗非包容性腰椎间盘突出症疗效确切,手术安全性高,创伤小,有望成为非包容性腰椎间盘突出症的--种微创高效的治疗手段。

Objective:This study was aimed to evaluate the feasibility,effectiveness and safety of combined therapy by two kinds of minimally invasive interventional techniques:percutaneous discectomy and epidural nerve release.Methods:From May 2014 to October 2017,among the 119 patients with non-inclusive lumbar disc hermiation,64 underwent percutaneous discectomy(control group)and 55 underwent percutaneous disectormy combined with epidural neurolysis(experimental group).The outcome was evaluated by visual ana-logue scale(VAS)and oswestry disability index(ODI).Results:All 119 patients were operated sessfully without serious complica-tions.All patients were followed up for a period of 11 to 18 months with an average of(13±2.8)months.Postoperative 1,3 and 6 months:VAS scores and clinical efficacy evaluation in the experimental group compared with the control group were(2.73±1.33vs.4.16±1.17;2.51±1.24 vs.3.71±1.19;2.48±1.16vs.3.96±1.37)and(37.50%vs 74.55%;45.31%vs 76.36%;43.75%vs 78.18%),which were significant respectively(P<0.05).Conclusion:Percutaneous discectomy combined with epidural nerve release are effective,safe surgical operation and small trauma,which is expected to be a minimally invasive and effective treatment for the treatment of non-inclusive lumbar disc hermiation.