摘要
目的探讨三种不同后路术式治疗腰椎间盘突出症的临床疗效。方法将2019年7月至2020年6月百色市人民医院收治的120例腰椎间盘突出症患者按照随机数字表分为三组,每组40例,Ⅰ组采用后路经椎板间隙入路椎间孔镜技术治疗,Ⅱ组采用后路椎间盘镜技术治疗,Ⅲ组采用传统后路腰椎板开窗减压+髓核摘除术治疗,比较三组患者的手术时间、术中出血量、切口长度、住院时间、住院费用、手术并发症、满意度、复发率,以及术前和出院时、术后3个月、术后6个月、术后1年的疼痛视觉模拟评分量表(VAS)评分与腰椎Oswestry功能障碍指数(ODI评分)、日本骨科协会腰椎评分(JOA)。结果三组手术时间、术中出血量、切口长度、住院时间及住院费用比较,差异均有统计学意义(P<0.05),其中Ⅰ组手术时间与Ⅱ组相当,但均短于Ⅲ组(P<0.05)。Ⅰ组术中出血量、切口长度、住院时间均少于或短于Ⅱ组和Ⅲ组,而住院费用高于Ⅱ组和Ⅲ组,比较差异有统计学意义(P<0.05)。三组术前VAS评分、ODI评分、JOA评分比较差异无统计学意义(P>0.05),术后各个时间的VAS评分、JOA评分、ODI评分比较差异均有统计学意义(P<0.05),随着时间延长,三组的VAS评分、ODI评分均逐渐下降,JOA评分均逐渐升高,且Ⅰ组VAS评分、ODI评分下降更显著,JOA评分升高更显著,差异均有统计学意义(P<0.05)。结论三种不同后路术式治疗腰椎间盘突出症均能取得满意的临床效果,但后路经皮椎间孔镜技术具有创伤小、疼痛轻、术后恢复快、安全性高、患者满意度高等优点,值得临床推广应用。
Objective To investigate the clinical effects of three different posterior approaches in the treatment of lumbar disc herniation.Methods 120 patients diagnosed with lumbar disc herniation who were admitted to Baise People's Hospital from July 2019 to June 2020 were divided into three groups according to random number table,with 40 cases in each group.GroupⅠwere treated with transforaminal percutaneous endoscopic discectomy,groupⅡwere treated with microendoscopic discectomy,and groupⅢwere treated with conventional posterior laminectomy decompression+discectomy.And then,operation time,intraoperative blood losses,incision length,length of hospital stay,hospitalization costs,surgical complications,satisfaction degree,recurrence rate as well as visual analog scale(VAS)scores,Oswestry disability index(ODI)scores and Japanese Orthopaedic Association(JOA)scores before surgery and at discharge,3 months,6 months and 1 year after surgery were recorded and compared between the three groups.Results There were statistically significant differences in operation time,intraoperative blood losses,incision length,length of hospital stay and hospitalization costs among the three groups(P<0.05),and the operation time of the groupⅠwas equivalent to that of the groupⅡ,but shorter than that of the groupⅢ(P<0.05).The intraoperative blood loss,incision length,length of hospital stay in the groupⅠwere less or shorter than those in the groupⅡand the groupⅢ,while the hospitalization cost was higher than that in the groupⅡand the groupⅢ,and difference was statistically significant(P<0.05).There were no statistically significant differences in the scores of VAS,ODI and JOA among the the three groups before surgery(P>0.05),but there were statistically significant differences among those scores at each time point after surgery(P<0.05).With the extension of time,the scores of VAS and ODI of the three groups decreased gradually,the JOA scores gradually increased,and the decrease of the scores of VAS and ODI of the groupⅠwere more significant,and the increase of JOA score was more significant,so differences were all statistically significant(P<0.05).Conclusion All of the three different posterior approaches in the treatment of lumbar disc herniation can achieve satisfactory clinical results,but percutaneous microendoscopic discectomy has the advantages of less trauma,less pain,rapid postoperative recovery,high safety and high patient satisfaction,which is worthy of clinical application.
作者
华树良
隆振学
韦文
赵勇
黄诚谦
陆春先
HUA Shuliang;LONG Zhenxue;WEI Wen;ZHAO Yong;HUANG Chengqian;LU Chunxian(Department of Spinal Osteopathy Surgery,Southwest Hospital Affiliated to Youjiang Medical University for Nationalities—Baise People's Hospital,Baise 533000,Guangxi,China)
出处
《右江医学》
2022年第2期113-118,共6页
Chinese Youjiang Medical Journal
基金
百色市科学研究与技术开发计划项目(百科20192529)。
关键词
脊柱内窥镜
脊柱微创手术
腰椎间盘突出症
髓核摘除术
经椎板间隙入路
endoscope of the spine
minimally invasive spine surgery
lumbar disc herniation
microendoscopic discectomy
transcinaspinal space approach