经皮椎间孔镜治疗腰椎间盘突出症时对神经根伴行血管保留的临床研究

发布时间：2018-04-21 15:20

本文选题：经皮椎间孔镜腰椎间盘突出髓核摘出术 + 腰椎间盘突出症　；参考：《湖北中医药大学》2016年硕士论文

【摘要】：目的:观察经皮椎间孔镜治疗腰椎间盘突出症时对神经根伴行血管保留与患者术后不适感及麻木感改善程度的关系。方法:回顾性分析2014年1月至2015年12月期间,广州军区武汉总医院骨科脊柱病区收治的133例腰椎间盘突出症患者,均在局麻+监护下行经皮椎间孔镜下髓核摘除手术,术中保存视频显示,有71例患者术中完整保留神经根伴行血管,62例患者未保留。观察患者术后不适感及患肢麻木感,统计手术时间,采用视觉模拟量表(VAS)评分评估患者术前与术后当天、术后三天、术后1月、术后三月、术后一年的腰腿痛缓解情况;腰椎JOA功能评分(29分法)评估术前与术后当天、术后三天、术后1月、术后三月、术后一年的症状缓解情况;ODI伤残指数(Oswestry disability index,ODI)功能评分对术前与术后1月、术后三月、术后一年腰椎功能进行评估结果:133例患者均顺利完成手术,无术中更改术式,术中均无神经根损伤及脑脊液漏,术后患者腰腿疼痛缓解,无椎间隙感染等并发症发生。通过定期门诊复查、电话联系和E—mail随访,133例患者术后三个月内全部获得随访,其中110例患者随访1年以上,术后一年保留组失访16例,失访率22.5%,未保留组失访7例,失访率11.3%,均随访3～22个月,平均14.5个月。保留神经根伴行血管组手术时间55～110min,平均71.5min;未保留神经根伴行血管组手术时间为54～82min,平均为62.1min,两组进行组间比较手术时间有统计学差异(P0.05)。保留组与未保留组手术前后直腿抬高试验,术后住院天数比较无统计学意义(P0.05)。保留组患者术后各阶段VAS评分、JOA评分、ODI评分与术前VAS评分、JOA评分、ODI评分比较均有统计学差异(P0.05)。未保留组患者术后各阶段VAS评分、JOA评分、ODI评分与术前VAS评分、JOA评分、ODI评分比较均有统计学差异(P0.05)。两组术后VAS评分、JOA评分及ODI评分进行组间比较,采用方差齐性检验,均满足正态分布,进行两组独立样本t检验,两组术后VAS、JOA评分组间比较有统计学意义(P0.05),术后ODI评分组间比较无统计学意义(P0.05)。结论:经皮椎间孔镜在治疗腰椎间盘突出症,具有靶向精准、创伤小,术后恢复快,手术时间较短,并发症少,对脊柱稳定性影响小,近期疗效可靠等优点;术中完整保留了神经根伴行血管的患者,术后出现腰腿部不适感及患肢麻木感较未保留的患者轻,近期疗效显著。
[Abstract]:Objective: to observe the relationship between the nerve root and vascular preservation in the treatment of lumbar disc herniation by percutaneous foraminal endoscopy and the improvement of postoperative discomfort and numbness. Methods: from January 2014 to December 2015, 133 patients with lumbar intervertebral disc herniation (LIDP) treated in Department of Orthopaedics, Wuhan General Hospital of Guangzhou military region were analyzed retrospectively. During the operation, 71 patients with intact nerve root preservation accompanied by vascularization were not preserved. The postoperative discomfort and numbness of the affected limbs were observed and the time of operation was counted. Visual analogue scale (VASS) was used to evaluate the relief of low back and leg pain before and after operation, three days after operation, one month after operation, three months after operation and one year after operation. Lumbar JOA score (29 points) was used to evaluate the symptom relief of preoperative and postoperative day, 3 days, 1 month, 3 months after operation and one year after operation. The scores of Oswestry disability index (ODI) were evaluated before and 1 month after operation, 3 months after operation, 3 months after operation, 1 month after operation, 3 months after operation, and 1 month after operation. Results one year after operation, 133 cases of lumbar vertebrae function were successfully operated without any change of operation, no nerve root injury and cerebrospinal fluid leakage, pain relief of lumbar and leg, and no complications such as intervertebral space infection. Through regular outpatient examination, telephone contact and E-mail follow-up all 133 patients were followed up within 3 months after operation. 110 cases were followed up for more than one year, 16 cases were lost in the retention group one year after operation, the missing rate was 22.5%, and 7 cases in the unretained group. All the patients were followed up for 3 ~ 22 months (mean 14.5 months). The operation time of the nerve root concomitant vascular group was 55 ~ 110min (mean 71.5 mins), while that of the unpreserved nerve root with vascular group was 54 ~ 82min (mean 62.1 mins). There was significant difference in the operation time between the two groups (P 0.05). There was no significant difference in the length of hospitalization between the retention group and the unreserved group before and after operation (P 0.05). In the retention group, there were significant differences between the VAS score and the preoperative VAS score and the preoperative VAS score and ODI score in each stage of the operation (P 0.05). There were significant differences in VAS scores and VAS scores between the patients in the unreserved group and those in the preoperative VAS scores and the preoperative VAS scores (P 0.05). The VAS scores and ODI scores were compared between the two groups after operation. The variance homogeneity test was used to satisfy the normal distribution, and the two groups of independent samples were tested by t test. There was significant difference between the two groups (P 0.05), but there was no significant difference between the two groups in ODI score (P 0.05). Conclusion: percutaneous foramen endoscopy has many advantages in the treatment of lumbar disc herniation, such as precise target, small trauma, quick recovery, short operation time, less complications, little influence on spine stability, reliable short-term curative effect, etc. The patients with intact nerve root and blood vessels had less discomfort and numbness in the waist and leg after operation than the patients without preserving the nerve root. The short-term curative effect was remarkable.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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