根性疼痛持续时间对经皮椎间孔镜下腰椎髓核摘除术临床疗效的影响

Effect of duration of radicular pain on clinical efficacy of percutaneous foraminal endoscopic lumbar discectomy

目的文中探讨术前根性疼痛症状持续时间对经皮椎间孔镜下腰椎髓核摘除术(PELD)临床效果的影响。方法回顾性分析2016年3月至2018年12月期间于江苏省中医院采用PELD治疗,且符合研究标准的腰椎间盘突出症患者320例。根据术前下肢根性疼痛症状持续时间分为<3个月组(A组)、3~6个月组(B组)、>6个月组(C组)。比较各组术前及术后下肢VAS评分,采用改良MacNab标准评价术后疗效,对比分析术前病程对于手术效果的影响。结果获得完整随访患者共272例,其中A组116例、B组76例、C组80例。A、B 2组患者末次随访时VAS评分改善值差异无统计学意义[(6.10±1.14)vs(6.03±1.14),P=0.65];但均与C组(4.85±1.03)间比较,差异有统计学意义(P<0.05)。A、B 2组患者术后MacNab评估优良率差异无统计学意义(91.38%vs 92.11%,P=0.978);但均显著高于C组(82.5%),差异有统计学意义(P<0.05)。结论PELD具有良好的安全性及有效性;且术前根性疼痛症状持续时间<6个月患者的临床效果相对更佳。

Objective To investigate the effect of duration of radicular pain symptoms on clinical efficacy of percutaneous foraminal endoscopic lumbar discectomy(PELD).Methods 320 patients with lumbar disc herniation who received PELD treatment in Jiangsu Provincial Hospital of Traditional Chinese Medicine from March 2016 to December 2018 were retrospectively analyzed.According to the duration of preoperative radicular pain symptoms of lower extremity,the patients were divided into three groups,namely less than 3 months group(group A),three to six months group(group B),and more than six months group(group C).Preoperative and postoperative VAS scores of lower extremities were compared in each group.The modified MacNab standard was used to evaluate the postoperative efficacy,and the influence of preoperative course of disease on the operative effect was compared and analyzed.Results A total of 272 patients were followed up,including 116 cases in group A,76 cases in group B and 80 cases in group C.There was no significant difference in VAS score improvement between group A and group B at the last follow-up[(6.10±1.14)vs(6.03±1.14),P=0.65].However,the difference was statistically significant compared with group C(4.85±1.03)(P<0.05).There was no significant difference between group A and group B in MacNab evaluation(91.38%vs 92.11%,P=0.978).However,they were significantly higher than group C(82.5%),and the difference was statistically significant(P<0.05).Conclusion PELD has good safety and efficacy.And the clinical efficacy of patients with preoperative radicular pain symptoms lasting less than 6 months is relatively better.