基于出院病案数据不同微创为主综合治疗131例腰椎间盘突出症患者临床资料回顾性分析

Retrospective Analysis of Clinical Data of Lumbar Disc Herniation Patients Treated with Different Minimally Invasive Treatment Based on Medical Record Data

目的基于出院病案数据回顾性分析不同微创为主综合治疗腰椎间盘突出症(Lumbar Disc Herniation,LDH)患者临床资料,了解LDH患者特征,提高临床医生对LDH的认识和诊治水平。方法根据不同微创治疗方法分为联合组、射频组、臭氧组,对3组患者治疗前基准水平,辅助检查,治疗前后视觉模拟评分法(Visual Anglongue Score,VAS)、日本骨科协会腰椎JOA评分法等临床资料进行回顾性分析,客观评定不同微创为主综合治疗方法的临床疗效。结果①纳入的131例LDH患者,男女比例为65∶66,平均年龄(50.14±9.69)岁。②3组体征治疗前两两相比差异无统计学意义(P>0.05);治疗后3组棘突间旁压痛、挺腹试验、左直腿抬高试验、右直腿抬高试验与治疗前比较,差异有统计学意义(P<0.01),拇趾背伸肌力、下肢浅感觉与治疗前比较,差异无统计学意义(P>0.05);3组左直腿抬高试验联合组与射频组、臭氧组相比,右直腿抬高试验联合组与射频组相比,差异有统计学意义(P<0.05);其它体征3组两两比较,差异无统计学意义(P>0.05)。③治疗前后VAS、JOA评分比较:组内比较,3组治疗后腰椎VAS、JOA评分与治疗前比均显著改善,差异有统计学意义(P<0.05)。组间比较,治疗后联合组腰椎VAS、JOA改善优于射频组、臭氧组,差异均有统计学意义(P<0.05);射频组与臭氧组比较,差异无统计学意义(P>0.05)。④联合组临床痊愈4例,显效25例,有效5例,无效0例,显效率为85.29%;射频组临床痊愈1例,显效22例,有效9例,无效4例,愈显率为63.89%;臭氧组临床痊愈0例,显效40例,有效17例,无效4例,愈显率为65.57%。愈显率差异有统计学意义(P<0.05),联合组疗效明显优于射频组、臭氧组。结论 LDH尚无特效治疗方法,传统方法结合现代微创技术综合治疗是一种很好的尝试,应该予以充分重视,回顾性分析为规范诊治、评估病情提供了一定的依据。

Objective To retrospectively analyze the clinical data of lumbar disc herniation(LDH)patients treated with different minimally invasive methods based on the discharged medical record data,so as to understand the characteristics of LDH patients and improve the level of diagnosis and treatment of LDH by clinicians. Methods According to different minimally invasive treatment methods,they were divided into combination group,radiofrequency group and ozone group. The clinical data of baseline level,auxiliary examination,VAS and JOA scores before and after treatment were retrospectively analyzed,and the clinical efficacy of different minimally invasive comprehensive treatment methods was evaluated objectively. Results ①131 patients with LDH were included,the ratio of male to female was 65∶66,and the average age was(50.14±9.69)years old.② There was no significant difference between the three groups before treatment(P>0.05);Between after and before treatment,there were significant differences in the paraspinous process tenderness,abdominal distending test,left straight leg raising test and right straight leg raising test in each group(P<0.01). There was no significant difference in the strength of extensor digitorum dorsalis and superficial sensation of lower limbs(P>0.05);There were significant differences in the left straight leg elevation test combined group with radio frequency group or ozone group,and between the right straight leg raising test combined group and radio frequency group(P<0.05);There was no significant difference in other signs between the three groups(P>0.05). ③ Comparison of vas and JOA scores before and after treatment:in the intra group comparison,the lumbar VAS and JOA scores of the three groups after treatment were significantly improved compared with those before treatment(P<0.05). After treatment,the improvement of lumbar vas and JOA in the combined group was better than that in the radiofrequency group or ozone group(P<0.05);there was no significant difference between the radiofrequency group and the ozone group(P>0.05). ④ In the combination group,4 cases were clinically cured,25 cases were markedly effective,5 cases were effective,and 0 case was ineffective,with the effective rate of 85.29%;As well in the radio frequency group,above data were 1,22,9,4 cases and 63.89% respectively;in the ozone group,above data were 0,40,17,4 cases and 65.57% respectively;The curative effect of the combination group was significantly better than that of the radio frequency group or ozone group(P<0.05). Conclusion There is no specific treatment method for LDH. The traditional method combined with modern minimally invasive technology is a good attempt,which should be paid attention to. The retrospective analysis provides a certain basis for standardized diagnosis and treatment and evaluation of disease condition.