经皮椎间孔镜髓核摘除术治疗腰椎间盘突出症患者的效果

Effects of percutaneous transforaminal endoscopic discectomy in the treatment of patients with lumbar disc herniation

目的:探讨经皮椎间孔镜髓核摘除术(PELD)治疗腰椎间盘突出症(LDH)患者的效果。方法:选取2022年1—10月该院收治的90例LDH患者进行前瞻性研究,采用随机数字表法将其分为对照组和观察组各45例。对照组采用传统椎板开窗髓核摘除术治疗,观察组采用PELD治疗。比较两组临床疗效、围术期指标(手术时间、术中出血量、下床活动时间、住院时间)、手术前后腰椎功能指标[直腿抬高角度、视觉模拟评分法(VAS)评分及Oswestry功能障碍指数(ODI)评分]、手术前后血清炎性因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平及并发症发生率。结果:观察组治疗优良率为95.56%(43/45),高于对照组的80.00%(36/45),差异有统计学意义(P<0.05);观察组手术时间、下床活动时间、住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后3个月,观察组直腿抬高角度大于对照组,VAS、ODI评分均低于对照组,差异有统计学意义(P<0.05);观察组术后3 d的血清CRP、TNF-α水平均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为2.22%(1/45),明显低于对照组的26.67%(12/45),差异有统计学意义(P<0.05)。结论:PELD治疗LDH患者可提高治疗优良率,减轻手术创伤,减少术中出血量,缩短手术时间、卧床时间和住院时间,降低术后疼痛程度和炎性因子水平,提高术后腰椎功能,效果优于传统椎板开窗髓核摘除术。

Objective:To investigate effects of percutaneous endoscopic lumbar discectomy(PELD)in treatment of patients with lumbar disc herniation(LDH).Methods:A prospective study was conducted on 90 patients with LDH admitted to this hospital from January to October 2022.They were divided into control group and observation group by using the random number table method,45 cases in each group.The control group was treated with traditional fenestration discectomy,while the observation group was treated with PELD.The clinical efficacy,the perioperative indexes(operation time,intraoperative blood loss,exercise time leaving bed,hospitalization time)levels,the lumbar function index levels before and after the surgery[straight leg elevation angle,visual analogue scale(VAS)score and Oswestry dysfunction index(ODI)score],the serum inflammatory factors before and after the surgery[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]levels,and the incidence of complications were compared between the two groups.Results:The excellent treatment rate of in the observation group was 95.56%(43/45),which was higher than 80.00%(36/45)in the control group,and the difference was statistically significant(P<0.05).The operation time,the exercise time leaving bed and the hospitalization time of the observation group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).Three months after the surgery,the straight leg elevation angle of the observation group was higher than that of the control group,the VAS and ODI scores were lower than those of the control group,and the differences were statistically significant(P<0.05).Three days after the surgery,the levels of serum CRP and TNF-αin the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 2.22%(1/45),which was significantly lower than 26.67%(12/45)in the control group,and the difference was statistically significant(P<0.05).Conclusions:PELD in the treatment of the LDH patients can improve the excellent treatment rate,reduce the surgical trauma,reduce the intraoperative blooding,shorten the operation time,the exercise time leaving bed and the hospitalization time,reduce the postoperative pain and the inflammatory factor levels,and improve the postoperative lumbar function.Moreover,it is superior to traditional fenestration discectomy.