两种关节突成形技术在治疗腰椎间盘突出症中的疗效比较

Comparison effect of two articular process formation techniques in the treatment of lumbar disc herniation

目的比较镜下电动磨钻关节突成形技术与手柄扩孔钻关节突成形技术在经皮内镜腰椎间盘切除术(PELD)中治疗腰椎间盘突出症的疗效。方法将41例腰椎间盘突出症患者根据关节突成形技术不同分为A组(行镜下电动磨钻关节突成形技术,22例)和B组(行手柄扩孔钻关节突成形技术,19例)。记录两组手术时间、术中透视次数,比较手术前后疼痛VAS评分、ODI评分。结果两组均顺利完成手术。B组1例发生术中手柄扩孔钻切割导丝断裂,镜下取出导丝断端。手术时间、术中透视次数A组短(少)于B组(P<0.05)。患者均获得随访,时间3~12(5.8±1.7)个月。疼痛VAS评分、ODI评分两组术后3个月均较术前明显改善(P<0.05),术后3个月A组优于B组(P<0.05)。结论PELD治疗腰椎间盘突出症短期效果满意,镜下电动磨钻行关节突成形技术可有效减少术中透视次数,操作安全高效,术后短期随访效果明显优于手柄扩孔钻关节突成形技术。

Objective To compare the efficacy of articular process formation with endoscopic electric grinding drill and handle reamer during percutaneous endoscopic lumbar discectomy(PELD)for treatment of lumbar disc herniation.Methods A total of 41 patients with lumbar disc herniation were divided into two groups:group A(endoscopic electric grinding articular process formation techniques,22 cases)and group B(handle reamer articular process formation,19 cases).Operation time and intraoperative fluoroscopy times were recorded,and pain visual analogue score(VAS)and ODI score were compared before and after operation.Results Both groups successfully completed the operation.In group B,1 case had guide wire fracture caused by handle reamer cutting during operation,and the broken end of guide wire was removed under endoscopic.The operative time and the intraoperative fluoroscopy times in group A were shorter(less)than those in group B(P<0.05).All patients were followed up for 3~12(5.8±1.7)months.Pain VAS and ODI score:the two groups were significantly improved at 3 months after surgery,compared with the preoperation(P<0.05),and group A was better than group B at 3 months postoperation(P<0.05).Conclusions PELD has a satisfactory short-term effect in the treatment of lumbar disc herniation.The endoscopic electric grinding drill can effectively reduce the fluoroscopy times,the intraoperative operation is safe and efficient,and the postoperative short-term follow-up effect is significantly better than the handle reamer articular process formation.