经皮脊柱内镜腰椎间盘摘除术治疗腰椎间盘突出症的临床效果及对患者疼痛程度的影响

目的:探讨经皮脊柱内镜腰椎间盘摘除术(PELD)治疗腰椎间盘突出症(LDH)的临床效果。方法:选取黔西南州中医院2021年6月—2023年6月收治的70例LDH患者,按随机数字表法分为两组,各35例。对照组行开放椎板开窗术,观察组行PELD,比较两组手术情况、疼痛程度、炎症水平、腰椎功能及生活质量。结果:观察组手术时间长于对照组,术中出血量少于对照组,下床活动时间及住院时间均短于对照组,差异均有统计学意义(P<0.05);观察组术后12、24、48 h时视觉模拟评分法(VAS)评分均低于对照组,差异均有统计学意义(P<0.05);观察组术后白细胞(WBC)、C反应蛋白(CRP)、血沉(ESR)水平均低于对照组,差异均有统计学意义(P<0.05);观察组术后日本骨科协会评估治疗分数(JOA)评分各维度及总分均高于对照组,差异均有统计学意义(P<0.05);观察组术后生活质量各领域评分均高于对照组,差异均有统计学意义(P<0.05)。结论:PELD治疗LDH效果显著,术后VAS评分低,利于腰椎功能恢复,减轻对生活的影响。

局部浸润麻醉下经皮脊柱内镜治疗对腰椎间盘突出症患者腰椎功能及疼痛评分的影响

目的:分析腰椎间盘突出症患者行局部浸润麻醉下经皮脊柱内镜治疗方案对于患者腰椎功能与疼痛评分的改善价值。方法:选取2022年01月至2023年12月期间于龙岩博爱医院诊疗的80例腰椎间盘突出症患者为观察对象,依据治疗方法不同分组,将实施椎间盘镜手术的40例患者列为对照组,实施局部浸润麻醉下经皮脊柱内镜的40例列为观察组,评价手术信息、术后腰椎功能与疼痛、脊柱稳定性。结果:较对照组,观察组手术时间、术中出血量、住院时间与卧床时间较低(P<0.05);术后6月,较对照组,生活料理情况、提举重物情况、坐立状况、睡眠状况、旅行状况、社会生活状况、行走状况、腰腿疼痛、站立状况观察组较低(P<0.05);较对照组,腰椎前凸观察组较高、胸椎后凸角、颌眉角、矢状面平衡观察组较低,其中腰椎前凸角(P<0.05);较对照组,观察组的手术并发症发生率较低(P<0.05)。结论:腰椎间盘突出症患者行局部浸润麻醉下经皮脊柱内镜治疗可显著提升患者的术后腰椎功能,减少疼痛,且手术损伤小,术后远期脊柱稳定性较佳,具有重要应用价值。

Treatment of extremely-lateral lumbar disc herniation with METRx through intertransversal route

Objective: To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In the period from March 2000 to December 2002, 9 patients with ELDH underwent disc resection with METRx system through intratransversal route and the clinical outcome was evaluated with Nakai standard. Results: The operation time ranged from 60 to 120 min with an average of 75 min; the blood loss ranged from 50 to 120 ml with an average of 60 ml; and the hospitalization time ranged from 5 to 19 d with an average of 13 d. No wound infection, neurological damages, pseudomeningocele or other complications occurred. The rate of excellent and good outcome was 88.9%. Conclusion: Disc removal in patients with ELDH can be done with METRx system and satisfactory results are obtained.