G型臂辅助下等离子射频消融术联合臭氧治疗包容型腰椎间盘突出症的临床观察及其复发的影响因素分析

Clinical observation of G-arm assisted plasma radiofrequency ablation combined with ozone in the treatment of inclusive lumbar disc herniation and analysis of the influencing factors of recurrence

目的观察G型臂辅助下等离子射频消融术联合臭氧治疗包容型腰椎间盘突出症的疗效,分析影响腰椎间盘突出症复发的相关因素。方法选择2017年5月至2019年7月北京市昌平区中西医结合医院骨科收治的包容型腰椎间盘突出症患者353例,按照随机数字表法分为微创手术治疗组 (n=180)和保守治疗组(n=173)。微创手术治疗组采用G型臂辅助下等离子射频消融术联合臭氧治疗,治疗1次,住院7 d为1个疗程;保守治疗组采用功能锻炼、对症止痛和物理治疗,1次/d,住院7 d为1个疗程。在治疗前,疗程结束后即刻,疗程结束后1、3、6、12个月采用视觉模拟评分法(VAS)观察疼痛改善情况,Oswestry功能障碍指数(ODI)评分评估疗效,比较2组的VAS、ODI评分;采用Logistic回归分析影响腰椎间盘突出症复发的影响因素。组间数据比较采用秩和检验或独立样 本t检验,组内数据比较采用配对样本t检验。结果失访21例,失访率为5.9%,其中微创手术治疗组失访9例,保守治疗组失访12例。微创手术治疗组、保守治疗组疗程结束后即刻与治疗前VAS评分比较,差异均有统计学意义 (t=3.15、2.73,P=0.013、0.032);治疗前,微创手术治疗组与保守治疗组VAS评分比较,差异无统计学意义 (t=0.66,P=0.596);疗程结束后即刻,疗程结束后1、3、6、12个月微创手术治疗组的VAS评分分别为(3.22±0.76)、(2.66±1.05)、(2.07±1.14)、(2.10±0.96)、(2.32±1.15)分,与保守治疗组[(4.07±1.37)、(3.76±1.14)、(2.63±1.17)、(2.63±1.41)、(3.23±1.21)分]比较,差异均有统计学意义 (t=3.09、2.75、2.46、2.11、1.96,P=0.004、0.029、0.043、0.045、0.042)。微创手术治疗组、保守治疗组疗程结束后即刻与治疗前ODI得分比较,差异均有统计学意义(t=2.75、2.73,P=0.003、0.011);治疗前,微创手术治疗组与保守治疗组ODI得分比较,差异无统计学意义(Z=1.63,P=0.632);疗程结束后即刻,疗程结束后1、3、6、12个月微创手术治疗组的ODI得分分别为(19.70±14.31)、(22.31±12.60)、(16.46±10.11)、(13.17±10.45)、(12.63±10.11)分,与保守治疗组[(20.43±13.14)、(21.57±14.11)、(18.72±13.17)、(17.64±14.22)、(13.09±10.22)分]比较,差异均有统计学意义(Z=2.24、1.95、1.66、1.78、1.69,P=0.013、0.032、0.036、0.040、0.044)。Logistic回归分析显示,患者年龄、负重劳累、生活作息、微创手术是腰椎间盘突出症复发的独立影响因素,差异均有统计学意义 (P=0.012、0.011、0.004、0.001)。性别、并发基础疾病(高血压、糖尿病、冠心病、脑血管病)、门诊复查与腰椎间盘突出症复发无关,差异均无统计学意义(P=0.232、0.076、0.054、0.140、0.251、0.085)。结论等离子射频消融术联合臭氧治疗包容型腰椎间盘突出症可取得显著的治疗效果,有效缓解患者的疼痛症状,改善患者ODI得分;随访发现保持规律的生活作息、避免腰部负重、早期积极微创手术干预可明显减少腰椎间盘突出症复发。

Objective To observe the effect of G-arm assisted plasma radiofrequency ablation combined with ozone in the treatment of inclusive lumbar disc herniation(LDH),and to analyze the relevant factors that affect the recurrence of LDH. Methods A total of 353 patients with inclusive LDH who were admitted to the Department of Third Orthopedics,Beijing Changping Hospital of Integrated Chinese and Western Medicine from May 2017 to July 2019 were divided into minimally invasive surgery treatment group( n =180)and conservative treatment group( n =173)according to the random number table method.The minimally invasive surgical treatment group was treated with plasma radiofrequency ablation assisted by G-arm combined with ozone therapy,the patients were treated once and hospitalized for 7 days as a course of treatment.The conservative treatment group used functional exercise,symptomatic analgesia and physical therapy,once a day,7 days of hospitalization as a course of treatment.Before treatment,immediately after the course of treatment,1,3,6,and 12 months after the course of treatment,the visual analogue scale(VAS)was used to observe the improvement of pain,the Oswestry dysfunction index(ODI)score was used to evaluate the effect,and the VAS and ODI scores of the two groups were compared.Logistic regression was used to analyze the factors affecting the recurrence of lumbar intervertebral LDH.Rank sum test or independent-sample t test was used for data between groups,and paired-sample t -test was used for data within groups. Results Twenty-one cases were lost to follow-up,the rate of loss to follow-up was 5.9%,including 9 cases in the minimally invasive surgery group and 12 cases in the conservative treatment group.The minimally invasive surgical treatment group and conservative treatment group immediately after the end of the course of treatment compared with the VAS score before treatment,the differences were statistically significant(t=3.15,2.73;P=0.013, 0.032).Before treatment,there was no significant difference in VAS score between the minimally invasive surgery treatment group and the conservative treatment group(t=0.66,P =0.596);Immediately after the treatment course,1,3,6,and 12 months after the treatment course the VAS scores of the surgical treatment group were(3.22±0.76),(2.66±1.05),(2.07±1.14),(2.10±0.96),(2.32±1.15)points,respectively,compared with the conservative treatment group[(4.07±1.37),(3.76±1.14),(2.63±1.17),(2.63±1.41),(3.23±1.21)points],the differences were statistically significant(t=3.09,2.75,2.46,2.11,1.96;P =0.004,0.029,0.043,0.045,0.042).The minimally invasive surgical treatment group and conservative treatment group immediately after the end of the course of treatment compared with the pre-treatment ODI scores,the differences werer statistically significant(t=2.75,2.73;P =0.003,0.011).Before treatment,there was no significant difference in ODI scores between the minimally invasive surgery treatment group and the conservative treatment group(Z=1.63,P= 0.632).Immediately after the treatment,1,3,6,12 months after the treatment,the ODI scores of the surgical treatment group were(19.70±14.31),(22.31±12.60),(16.46±10.11),(13.17±10.45),(12.63±10.11)points,compared with the conservative treatment group[(20.43±13.14),(21.57±14.11),(18.72±13.17),(17.64±14.22),(13.09±10.22)points],the differences were statistically significant(Z=2.24,1.95,1.66,1.78,1.69;P =0.013,0.032,0.036,0.040,0.044).Logistic regression analysis showed that the patients′age,weight-bearing fatigue,living life,and minimally invasive surgery were independent factors influencing the recurrence of LDH,which were statistically significant(P=0.012,0.011,0.004,0.001).Gender,concurrent underlying diseases(hypertension,diabetes,coronary heart disease,cerebrovascular disease),outpatient reexamination were not associated with recurrence,which were not statistically significant(P=0.232,0.076,0.054,0.140,0.251,0.085). Conclusions Plasma radiofrequency ablation combined with ozone for treatment of inclusive LDH can achieve significant therapeutic effects,effectively alleviate the patient′s pain symptoms and improve the patient′s ODI score.The follow-up found to maintain regular life habits,avoid lumbar weight bearing,and early active minimally invasive surgical intervention can significantly reduce the recurrence of LDH.