MED和PELD治疗腰椎间盘突出症的疗效随访与分析

发布时间：2018-04-28 06:33

本文选题：椎间孔镜 + 显微内窥镜　；参考：《广西中医药大学》2017年硕士论文

【摘要】：目的:通过本随访比较经皮椎间孔镜下腰椎间盘切除术(percutaneous endoscopic lumbar discectomy,PELD)与后路显微内窥镜下腰椎间盘切除术(microendoscopic discectomy,MED)治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床指标,为临床治疗LDH方案选择提供借鉴意义。方法:选取2014年10月至2016年08月60例确诊为单节段腰椎间盘突出症的收治住院患者,根据手术方式分为PELD组和MED组,通过记录两组病例患者体重指数、年龄因素、患者病程长短、中医证型、术后住院时间,术后按中医证型给予患者口服院内制剂膏方,术后采用视觉模拟量表(visual analogue scale,VAS)评分、JOA和Oswestry功能障碍指数(Oswestry disability index,ODI)进行随访,所得结果进行统计学分析评估疗效。结果:随访到59例。MED组28例,PELD组31例。1.基本资料对比:经单因素方差分析,两组间患者年龄、体重指数和病程分布无差异无统计学意义(P0.05),提示两组患者的年龄、体重指数及病程构成比无明显差异。两组间性别构成比较差异无统计学意义(P0.05)。2.两组手术出血量、住院时间组间对比:住院时间、术中出血量组间对比差异有统计学意义(P0.05),提示PELD组在住院时间及术中出血量方面优于MED组。3.MED组和PELD组组内前后疗效评分分别对比:两组在手术前、手术后组内比较显示,根据腰椎JOA,VAS,ODI评分差异有统计学意义(P0.05),MED组和PELD组手术后症状及功能较术前均效果显著,说明术后患者症状有明显好转。4.MED组与PELD组组间手术前后疗效评分对比:组间比较显示,两组腰椎JOA,VAS,ODI评分组间对比评分无统计学意义(P0.05),两组术后病人疗效比较无明显区别,MED组与PELD组在随访期间内取得了相似的临床疗效,两组比较手术后3天VAS评分有统计学意义(P0.05),差异有显著性,说明PELD组术后患者疼痛症状3天内明显好于MED组。5.MED组与PELD组不同年龄段,体重指数,中医证型疗效评分对比显示:两组腰椎JOA改善率,末次ODI评分组组间对比评分无统计学意义(P0.05),两组术后病人疗效比较无显著差异,MED组与PELD组在不同年龄段,体重指数,中医证型疗效差异研究中未体现疗效差异。结论:1.本研究两种治疗措施PELD和MED均对治疗腰椎间盘突出症引起的腰腿痛均有效且效果相当,PELD和MED的疗效差异还不能明确,只有严格把握适应症和突破学习曲线后熟练操作才能得到最佳疗效。2.体现微创上PELD相比MED具有短期疼痛改善快,术中出血少,术后住院短,术后恢复快等优势,对于腰椎稳定性尚可的老年患者,PELD可取得满意的疗效。
[Abstract]:Objective: to compare the clinical indexes of percutaneous endoscopic lumbar discectomylotomy (endoscopic lumbar) and microendoscopic discectomy (endoscopic lumbar) in the treatment of lumbar intervertebral disc herniation (LIDH). To provide a reference for clinical treatment of LDH regimen selection. Methods: from October 2014 to August 2016, 60 inpatients with single segment lumbar disc herniation were selected and divided into PELD group and MED group according to the operation method. The body mass index and age factors of the two groups were recorded. The duration of the disease, the type of TCM syndromes, the duration of hospitalization after operation, and the oral preparation ointment were given to the patients according to the type of TCM syndromes. The visual analogue scale (VAS) score and the index of Oswestry dysfunction (Oswestry disability index ODI) were followed up after operation. The results were evaluated by statistical analysis. Results: a follow-up of 59 cases. MED group 28 cases of PELD group 31 cases. 1. Comparison of basic data: there was no significant difference in age, body mass index and course of disease distribution between the two groups by univariate ANOVA, indicating that there was no significant difference in age, body mass index and the proportion of course of disease between the two groups. There was no significant difference in sex composition between the two groups (P 0.05. 2). The amount of blood lost in operation and the length of hospitalization were compared between the two groups: length of stay, The difference of intraoperative bleeding volume was statistically significant (P 0.05), which suggested that PELD group was better than MED group in terms of hospitalization time and intraoperative bleeding volume. 3. The scores of curative effect before and after operation in MED group and PELD group were compared: the comparison between the two groups before and after operation showed that: 1. According to the difference in the scores of VAS-ODI of lumbar vertebrae, there was significant difference in the symptoms and functions after operation in P0.05 and PELD groups, which indicated that the symptoms of the patients after operation were obviously improved. 4. The scores of pre-and post-operation efficacy between MED group and PELD group were compared: the comparison between the two groups showed that the symptoms and functions of the two groups were significantly better than those of before and after operation. There was no significant difference in the scores between the two groups (P 0.05). There was no significant difference in the curative effect between the two groups. Similar clinical results were obtained between the MED group and the PELD group during the follow-up period. There was a significant difference in VAS scores between the two groups at 3 days after operation, which indicated that the pain symptoms in PELD group were significantly better than those in MED group and PELD group within 3 days, and the body mass index (BMI) was significantly better than that in MED group and PELD group. The scores of TCM syndromes showed that the improvement rate of lumbar JOA was not significant in the last ODI score group, and there was no significant difference in the curative effect between the two groups. There was no significant difference between the two groups in terms of age, body mass index (BMI), body mass index (BMI). The difference of curative effect was not reflected in the study of the difference of TCM syndromes. Conclusion 1. In this study, both PELD and MED were effective in the treatment of lumbago and leg pain caused by lumbar disc herniation. Only by mastering the indication and breaking through the learning curve can we get the best curative effect. 2. Compared with MED, minimally invasive PELD has the advantages of quick improvement of short-term pain, less intraoperative bleeding, short hospital stay and quick postoperative recovery. It can obtain satisfactory curative effect for elderly patients with stable lumbar vertebrae.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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