经皮椎间孔镜下髓核摘除联合心理疏导治疗腰椎间盘突出症合并焦虑的疗效观察

Effect of percutaneous intervertebral foraminal nucleus removal combined with psychological counseling in the treatment of patients with lumbar disc herniation complicated with anxiety

目的:观察经皮椎间孔镜下髓核摘除联合心理疏导治疗腰椎间盘突出症(LDH)合并焦虑的疗效。方法:本研究纳入2014年10月至2019年10月期间收治的116例合并焦虑的LDH患者,按随机数字表法分为对照组和观察组(各58例)。对照组行后路小切口椎板间隙入路髓核摘除并心理疏导,观察组行经皮孔镜入路内镜下髓核摘除及心理疏导。对比两组临床疗效,对患者术前、术后1d、1个月和3个月采用疼痛视觉模拟评分(VAS)和功能障碍情况ODI评分系统进行症状改善程度评价。终末随访时采用改良MacNab标准评定近期总体治疗疗效。并记录围手术期出血情况和血液检验实验室结果。同时对围手术期指标和焦虑状态进行评估分析。结果:观察组治疗总有效率[96.6%(56/58)]高于对照组[84.5%(49/58)](P<0.05);两组患者术前VAS评分及ODI评分比较,差异无统计学意义(P>0.05)。观察组术后各时间点VAS评分及ODI评分、围手术期出血情况和血液检验实验室结果以及围手术期指标和焦虑状态均优于对照组(P<0.05)。结论:经皮椎间孔镜下髓核摘除联合心理疏导治疗有效改善了LDH合并焦虑患者的长期腰背疼痛以及患者的焦虑状态。

Objective: To observe the effect of percutaneous foraminal nucleus pulposus excision combined with psychological counseling on lumbar disc herniation(LDH) combined with anxiety. Methods: A total of 116 patients with LDH complicated with anxiety admitted in from October 2014 to October 2019 were randomly divided into a control group and an observation group, with 58 cases in each group. The patients in the control group received nucleus pulposus extraction and psychological counseling through a small posterior incision interlaminar approach, while those in the observation group received endoscopic nucleus pulposus extraction and psychological counseling through a percutaneous foraminal approach. Clinical efficacy of the two groups was compared, and symptom improvement was evaluated by visual analogue scale(VAS) and dysfunction ODI scoring system before 1 day, 1 month and 3 months after surgery. The recent overall treatment efficacy was assessed using the modified Mac Nab standard at the final follow-up. Perioperative bleeding and laboratory results of blood tests were recorded. At the same time, the perioperative indicators and anxiety state were evaluated. Results: The total effective rate of the observation group [96.6%(56/58)] was higher than that of the control group [84.5%(49/58), P<0.05]. There was no statistical significance in preoperative VAS score and ODI score between the two groups(P>0.05). The VAS score and ODI score at each time point after surgery, the results of perioperative bleeding and blood test, and the perioperative indexes and anxiety state in the observation group were significantly better than those in the control group(P<0.05). Conclusion: Percutaneous foraminal nucleus pulposus excision combined with psychological counseling effectively improved the long-term low back pain and anxiety state of LDH patients.