经皮椎间孔镜椎间盘突出髓核摘除术治疗腰椎间盘突出症的近远期效果及对患者VAS、ODI、JOA评分的影响

Short-term and Long-term Effects of Percutaneous Foraminal Endoscopic Discectomy for Herniated Nucleus in the Treatment of Lumbar Disc Herniation and Its Influence on Patients’ VAS, ODI and JOA Scores

目的:探讨经皮椎间孔镜椎间盘突出髓核摘除术治疗腰椎间盘突出症的近远期效果及对患者VAS、ODI、JOA评分的影响。方法:选取2018年9月-2020年7月阜新市第二人民医院收治的90例腰椎间盘突出症患者为此次研究对象。根据手术方式的不同将90例患者分为研究组与对照组,每组45例。对照组实施经皮椎间盘镜腰椎髓核摘除术,研究组实施经皮椎间孔镜椎间盘突出髓核摘除术。观察并对比两组围术期相关指标,近远期疗效,术后1 d、1个月、3个月疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科治疗协会评估(JOA)分数。结果:研究组术中失血量少于对照组,手术时间短于对照组,差异均有统计学意义(P<0.05);但两组术后住院时间、术后下地时间比较,差异均无统计学意义(P>0.05)。两组术后6个月总有效率比较,差异无统计学意义(χ^(2)=0.714,P>0.05);研究组术后12个月总有效率高于对照组(χ^(2)=5.414,P<0.05)。两组术后1 d、1个月、3个月VAS、ODI、JOA评分比较,差异均无统计学意义(P>0.05);但两组术后1个月VAS、ODI、JOA均较术后1 d均明显改善,且术后3个月较术后1个月均明显改善,差异均有统计学意义(P<0.05)。结论:经皮椎间盘镜腰椎椎髓核摘除术、经皮椎间孔镜椎间盘突出髓核摘除术治疗腰椎间盘突出症的近期效果相当,且均可有效改善患者的疼痛程度、腰椎功能等指标,但后者治疗的患者围术期指标更优,远期疗效更佳,对患者造成的创伤更小。

Objective:To analyze and explore the short-term and long-term effects of percutaneous foraminal endoscopic discectomy in the treatment of lumbar disc herniation and its impact on patients’ VAS,ODI and JOA scores.Method:A total of 90 cases of lumbar disc herniation treated in the Second People’s Hospital of Fuxin from September 2018 to July 2020 were selected as the research objects.According to the different surgical methods,90 patients were divided into the study group and the control group,45 cases in each group.The control group was treated with percutaneous discoscopic lumbar nucleus pulposus,and the study group was treated with percutaneous foraminal endoscopic discectomy for herniated nucleus.The perioperative related indexes,short-term and long-term efficacy,visual analogue scale (VAS),Oswestry disability index (ODI) and Japanese orthopaedic association (JOA) score before and after treatment at 1 d,1 month 3 months after operation were observed and compared between two groups.Result:The intraoperative blood loss in the study group was less than that in the control group,and the operation time was shorter than that in the control group,the differences were statistically significant (P<0.05);however,there were no significant differences between two groups in postoperative hospital stay and postoperative landing time (P>0.05).There was no significant difference in the total effective rate between two groups at 6 months after operation (χ^(2)=0.714,P>0.05);the total effective rate in the study group at 12 months after operation was higher than that in the control group (χ^(2)=5.414,P<0.05).There were no significant differences in the VAS,ODI and JOA scores between two groups at 1 d,1 month and 3 months after operation (P>0.05);however,the VAS,ODI and JOA scores in two groups were significantly improved at 1 month after operation were significantly improved compared with at 1 d after operation,those at 3 months after operation were significantly improved compared with at 1 month after operation,the differences were statistically significant (P<0.05).Conclusion:Percutaneous discoscopic lumbar nucleus pulposus and percutaneous foraminal endoscopic discectomy for herniated nucleus pulposus have similar short-term effects in the treatment of lumbar disc herniation,and can effectively improve patients’ pain and lumbar function,however,the patients treated by the latter have better perioperative indicators,better long-term curative effect and less trauma to patients.